Utility of computed tomography, MRI, and bronchoscopy in severe pediatric asthma

Diagnostic methodComments
Computed tomographyIt can identify structural alterations in severe asthma (air trapping, bronchial thickening, or bronchiectasis) early on. It can also detect airway remodeling and small airway dysfunction and monitor the site of pulmonary aerosol deposition.
MRIFunctional MRI with hyperpolarized gases allows measurement of regional pulmonary ventilation with the percentage of ventilation defects and the number of defects per slice found in asthma with a higher treatment burden. It also detects improvement in inhomogeneity with treatment that cannot be detected by other methods.
BronchoscopyIt allows differential diagnosis with other abnormalities that simulate or coexist with severe asthma. Used with BAL, it increases the performance in the diagnosis of bacterial infection. It allows the diagnosis of inflammatory cell patterns, endobronchial, and molecular inflammation that is related to severe asthma with increased use of corticosteroids or worse lung function.

MRI: magnetic resonance imaging; BAL: bronchoalveolar lavage