Visualizing Improvements in Airway Dysfunction After Inhaled Therapy in Patients With Uncontrolled Asthma: A Narrative Review
Bibliographic record
Abstract
Clinical trials investigating asthma therapies typically rely on pulmonary function tests including spirometry markers, such as forced expiratory volume in 1 s, to evaluate efficacy. While these measures provide insights into the action of bronchodilators on global lung function, their specific effects on the airways and the relationship between clinical improvements and airway dysfunction remains poorly understood. In recent years, pulmonary functional imaging methods, such as hyperpolarized 129 Xe magnetic resonance imaging (MRI), have enabled the analysis of airway dysfunction in patients with asthma utilizing ventilation defect percent (VDP). In this narrative review, we summarize clinical evidence about the impact of inhaled bronchodilator therapies on airway dysfunction in patients with asthma, focusing on studies that utilized 129 Xe MRI to visualize and quantify MRI VDP. 129 Xe MRI VDP has been shown to be a well-tolerated and sensitive technique for enabling the visualization and quantification of airway functional changes over time in patients with asthma. This has been shown not only in a controlled clinical trial environment but also in a real-world setting, in patients with both controlled and poorly controlled asthma. A recent study evaluating single-inhaler triple therapy in patients with uncontrolled moderate–severe asthma, despite inhaled corticosteroid/long-acting β 2 -agonist maintenance therapy, demonstrated that daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI 200/62.5/25 µg) led to significantly improved 129 Xe MRI VDP after only 6 weeks, which was in line with broader central/distal airway function and quality of life improvements. These results highlight the capacity of 129 Xe MRI VDP to detect early responses to treatment. In addition, the mechanistic insights provided by 129 Xe MRI VDP also indicated that these benefits are likely due to the combination of UMEC (a long-acting muscarinic antagonist) and an efficacious inhaled corticosteroid, addressing undertreated inflammatory bronchoconstriction, helping to restore airway caliber and function that more closely resemble the airways of a healthy individual. Videos available for this article.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".