CT imaging in children with non-severe asthma and cough-variant asthma: functional spasm or structural remodeling?

Objective To investigate the role of CT-measured bronchial wall thickness and area in detecting airway remodeling in children with non-severe asthma and cough-variant asthma. Methods A retrospective review was conducted on 140 children who were assigned to the non-severe asthma (AS, n = 51), cough-variant asthma (CVA, n = 50) and control (CTL, n = 39) groups at Chengdu Women’s and Children’s Central Hospital from January 2023 to June 2025. Clinical characteristics, pulmonary function, and CT-measured parameters were compared across the groups. Results The wall area (WA), wall thickness (WT), wall area percentage (WA%), and wall thickness percentage (WT%) were measured in the third and fourth segments of right upper lobe apical segmental bronchus (RB1), right lower lobe posterior basal segmental bronchus (RB10) and left lower lobe posterior basal segmental bronchus (LB10). These parameters were significantly higher in both the AS and CVA groups compared to the CTL group ( p < 0.05). No statistically significant differences in age, gender, white blood cell count (WBC) or eosinophil count (EOS) were observed between the patient group (AS and CVA) and CTL group. Based on pulmonary function results, children with asthma or CVA were divided into groups with or without small airway dysfunction (SAD) and with or without obstructive ventilatory disorder (OVD). The comparative analysis showed that the majority of CT-measured parameters did not exhibit any statistically significant differences when comparing the SAD group to the non-SAD group, or the OVD group to the non-OVD group. Conclusion In conclusion, the CT results suggest that there may be airway remodeling in non-severe asthma and CVA patients in the early stages of the disease. Although patients with CVA differ from those with classic asthma in their clinical presentation and pulmonary function, they may share the same pattern of airway remodeling.