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Am J Nucl Med Mol Imaging 2013;3(4):350-360
Original Article
The effect of omalizumab on ventilation and perfusion in adults with allergic
asthma
Daniel A Kelmenson, Vanessa J Kelly, Tilo Winkler, Mamary T Kone, Guido Musch, Marcos F Vidal Melo, Jose G Venegas, R Scott
Harris
The Department of Medicine, Pulmonary and Critical Care Unit, Massachusetts General Hospital and Harvard Medical School,
Boston, MA, USA; The Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard
Medical School, Boston, MA, USA
Received April 22, 2013; Accepted May 23, 2013; Epub July 10, 2013; Published July 15, 2013
Abstract: Omalizumab promotes clinical improvement in patients with allergic asthma, but its effect on pulmonary function is
unclear. One possibility is that omalizumab improves asthma symptoms through effects on the regional distributions of ventilation,
perfusion, and ventilation/perfusion matching, metrics which can be assessed with Nitrogen-13-saline Position Emission
Tomography (PET). Four adults with moderate to severe uncontrolled allergic asthma underwent symptom assessment, spirometry
and functional pulmonary imaging with Nitrogen-13-saline PET before and after 4-5 months of treatment with omalizumab. PET
imaging was used to determine ventilation/perfusion ratios, the heterogeneity (coefficient of variation, COV) of ventilation and
perfusion, and lung regions with ventilation defects. There were no significant changes in spirometry values after omalizumab
treatment, but there was a trend towards an improvement in symptom scores. There was little change in the matching of ventilation
and perfusion. The COV of perfusion was similar before and after omalizumab treatment. The COV of ventilation was also similar
before (0.57 (0.28)) and after (0.66 (0.13)) treatment, and it was similar to previously published values for healthy subjects. There
was a non-significant trend towards an increase in the extent of ventilation defects after omalizumab treatment, from 5 (15)% to 12.8
(14.7)%. Treatment of moderate to severe uncontrolled allergic asthma with omalizumab did not result in a significant improvement
in ventilation and perfusion metrics assessed with functional PET imaging. The normal COV of ventilation which was unaffected by
treatment supports the hypothesis that omalizumab exerts its clinical effect on lung function during allergen exposure rather than in
between exacerbations. (ajnmmi1304002).
Keywords: PET functional imaging, omalizumab, Xolair, asthma, V/Q ratios
Address correspondence to: Dr. R Scott Harris, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
02114-2696, USA. Tel: 617-726-1721; Fax: 617-726-6878; E-mail: RSHarris@mgh.harvard.edu
Original Article
The effect of omalizumab on ventilation and perfusion in adults with allergic
asthma
Daniel A Kelmenson, Vanessa J Kelly, Tilo Winkler, Mamary T Kone, Guido Musch, Marcos F Vidal Melo, Jose G Venegas, R Scott
Harris
The Department of Medicine, Pulmonary and Critical Care Unit, Massachusetts General Hospital and Harvard Medical School,
Boston, MA, USA; The Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard
Medical School, Boston, MA, USA
Received April 22, 2013; Accepted May 23, 2013; Epub July 10, 2013; Published July 15, 2013
Abstract: Omalizumab promotes clinical improvement in patients with allergic asthma, but its effect on pulmonary function is
unclear. One possibility is that omalizumab improves asthma symptoms through effects on the regional distributions of ventilation,
perfusion, and ventilation/perfusion matching, metrics which can be assessed with Nitrogen-13-saline Position Emission
Tomography (PET). Four adults with moderate to severe uncontrolled allergic asthma underwent symptom assessment, spirometry
and functional pulmonary imaging with Nitrogen-13-saline PET before and after 4-5 months of treatment with omalizumab. PET
imaging was used to determine ventilation/perfusion ratios, the heterogeneity (coefficient of variation, COV) of ventilation and
perfusion, and lung regions with ventilation defects. There were no significant changes in spirometry values after omalizumab
treatment, but there was a trend towards an improvement in symptom scores. There was little change in the matching of ventilation
and perfusion. The COV of perfusion was similar before and after omalizumab treatment. The COV of ventilation was also similar
before (0.57 (0.28)) and after (0.66 (0.13)) treatment, and it was similar to previously published values for healthy subjects. There
was a non-significant trend towards an increase in the extent of ventilation defects after omalizumab treatment, from 5 (15)% to 12.8
(14.7)%. Treatment of moderate to severe uncontrolled allergic asthma with omalizumab did not result in a significant improvement
in ventilation and perfusion metrics assessed with functional PET imaging. The normal COV of ventilation which was unaffected by
treatment supports the hypothesis that omalizumab exerts its clinical effect on lung function during allergen exposure rather than in
between exacerbations. (ajnmmi1304002).
Keywords: PET functional imaging, omalizumab, Xolair, asthma, V/Q ratios
Address correspondence to: Dr. R Scott Harris, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
02114-2696, USA. Tel: 617-726-1721; Fax: 617-726-6878; E-mail: RSHarris@mgh.harvard.edu
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