Functional respiratory imaging (FRI) for optimizing therapy development and patient care

Abstract

Functional imaging techniques offer the possibility of improved visualization of anatomical structures such as; airways, lobe volumes and blood vessels. Computer-based flow simulations with a three-dimensional element add functionality to the images. By providing valuable detailed information about airway geometry, internal airflow distribution and inhalation profile, functional respiratory imaging can be of use routinely in the clinic. Three dimensional visualization allows for highly detailed follow-up in terms of disease progression or in assessing effects of interventions. Here, we explore the usefulness of functional respiratory imaging in different respiratory diseases. In patients with asthma and COPD, functional respiratory imaging has been used for phenotyping these patients, to predict the responder and non-responder phenotype and to evaluate different innovative therapeutic interventions.

KEYWORDS:

• COPD FRI
• phenotype
• personalized treatment

Financial and competing interests disclosure

B Hajian is a pulmonologist at the University Hospital Antwerp. She is doing clinical research in the field of enhanced COPD phenotyping to improve treatment strategies. J De Backer, C Van Holsbeke and V Wim are affiliated with Fluidda NV. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• For personalized treatment, there is a great need for improved understanding of disease pathophysiology and recognition of disease heterogeneity and complexity.

• Functional respiratory imaging is very useful to meet this challenge.

• Asthma and chronic obstructive pulmonary disease are diseases with different phenotypes.

• Functional respiratory imaging gives regional information, which could be helpful in choosing the most adequate treatment approach.

• The expected benefit of functional respiratory imaging (FRI) is the ability to assess the pharmacodynamic effect of a novel compound in a limited set of patients due to the enhanced sensitivity of the FRI outcome parameters.