Utilizing chest CT to assess the impact of omalizumab treatment on airway remodeling in refractory asthma

Background: To evaluate the benefits of omalizumab treatment in patients through real-world clinical follow-up data and assess the impact of omalizumab treatment on airway remodeling using chest CT. Methods This is a single-center prospective cohort study conducted in the Department of Respiratory and Critical Care Medicine of our hospital from May 2021 to December 2022, focusing on refractory asthma patients who received omalizumab treatment during this period. A comparison was made between the pre-treatment and post-treatment laboratory indicators, pulmonary function parameters, airway parameters, and mucous plug scores obtained from chest CT. Results This study included a total of 61 patients with refractory asthma treated with omalizumab. The study found that: ①regardless of whether the treatment lasted for a full four months or not, it significantly improved patient asthma control scores and reduced hospitalization costs and length of stay (p < 0.05). ②After four months of treatment, patients showed a decrease in FENO levels and central airway resistance (Rc) (p < 0.05) as measured by airway resistance examination. Pulmonary ventilation function examination revealed significant improvements (p < 0.05) in MEF75, MEF50, MEF75/25, PEF, and FEV1/FVC. ③After four months of omalizumab treatment, the ratio of wall thickness and outer radius (T/D) and wall area percentage (WA%) of the bronchial wall decreased significantly (p < 0.05). ④After medication, the expression of airway mucous plugs decreased. The mucous plug score was negatively correlated with several indicators of large and small airway function. Conclusions Omalizumab treatment can remodel the airways in refractory asthma patients, reducing airway wall thickness, decreasing the percentage of airway wall area, and reducing the expression of airway mucous plugs, thereby improving airflow limitation. Utilizing chest CT provides a novel and intuitive assessment of the efficacy of omalizumab treatment, offering a new perspective for the analysis of omalizumab treatment efficacy. Trial registration: This study was registered in Chinese Clinical Trial Registry, the number is ChiCTR2100046343.