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Soichiro Hanada,1,* Masato Muraki,1,* Yoshiyuki Kawabata,1 Kazuya Yoshikawa,1 Toshiyuki Yamagata,1 Tadao Nagasaki,1 Yushiro Ohara,2 Naoki Oiso,2 Hisako Matsumoto,3 Yuji Tohda4 1Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, Ikoma, Nara, Japan; 2Department of Dermatology, Kindai University Nara Hospital, Ikoma, Nara, Japan; 3Department of Respiratory Medicine and Allergology, Kindai University Hospital, Osakasayama, Osaka, Japan; 4Kindai University Hospital, Osakasayama, Osaka, Japan*These authors contributed equally to this workCorrespondence: Masato Muraki, Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, 1248-1 Otoda-cho, Ikoma, Nara, 630-0293, Japan, Tel +81 743 77 0880, Fax +81 743 77 0890, Email muraki-m@med.kindai.ac.jpPatients and Methods: A questionnaire survey was administered to 18, 14, and 3 patients introduced to home self-injection of dupilumab or mepolizumab using a pen-type device for atopic dermatitis, asthma alone, and asthma plus chronic rhinosinusitis with nasal polyps, respectively.Results: All but one participant wished to continue self-injection. Most participants affirmed the reduction in copayment (88.6%) and saving time and labor for hospital visits (88.6%). Six patients who received dupilumab complained of side effects, but all, except for one, continued the treatment. Of the 13 patients who had previously used a syringe-type device, 10 preferred the pen type because of its ease of use, while 3 (23%) preferred the syringe type because of the self-adjustable injection speed for pain control.Conclusion: Administration of biologics using pen-type devices is easier, and the introduction of home self-injection leads to a reduction in outpatient visits and copayment.Keywords: dupilumab, mepolizumab, self-injection, asthma, atopic dermatitis, chronic sinusitis with nasal polyps

Kazuyoshi Kurashima,1 Yotaro Takaku,1 Toshiko Hoshi,2 Tetsu Kanauchi,2 Keitaro Nakamoto,1 Noboru Takayanagi,1 Tsutomu Yanagisawa,1 Yutaka Sugita,1 Yoshinori Kawabata3 1Respiratory Medicine, 2Radiology, 3Pathology, Saitama Cardiovascular and Respiratory Center, Saitama, Japan Objective: The aim of this study was to evaluate the relationship between computed tomography assessed lobe-based lung parameters and the clinical outcomes of patients with chronic obstructive pulmonary disease (COPD), including the frequency of exacerbation and annual change in forced expiratory volume in 1 second (FEV1). Patients and methods: We studied 65 patients with COPD. We reconstructed computed tomography images to trace the bronchial tree from right B1 to B10 and created 3 cm circle images around the airways exactly perpendicular to the airway axis in the central, middle, and peripheral zones of the bronchi. The number of airways and vessels, airway inner diameter and area of emphysema in the circles were calculated for each segment. Then, we analyzed the relationships between the lobe-based image parameters and the frequency of exacerbation and annual decline in the FEV1. In addition, we assessed the effects of proximal airway lumen-obliterated emphysema (ALOE) on these clinical features. Results: The airway diameter was not associated with the frequency of exacerbation or annual decline in FEV1. Among the structural parameters, lower lobe emphysema was most associated with the frequency of exacerbation. The reductions in the number of airways and vessels in total lobe were associated with the annual decline in FEV1. The subgroup of patients with ALOE demonstrated lower FEV1 and more frequent exacerbation than those without ALOE. Conclusion: Lower lobe emphysema predicts frequent COPD exacerbation, whereas the annual decline in FEV1 is associated with the number of airways and vessels in total lobe. Keywords: chronic obstructive pulmonary disease, computed tomography, acute exacerbation, pulmonary function tests, low attenuation area

Kazuyoshi Kurashima,1 Toshiko Hoshi,2 Yotaro Takaku,1 Tetsu Kanauchi,2 Keitaro Nakamoto,1 Miyuki Ueda,2 Noboru Takayanagi,1 Thomas V Colby,4 Yutaka Sugita,1 Yoshinori Kawabata3 1Department of Respiratory Medicine, 2Department of Radiology, 3Department of Pathology, Saitama Cardiovascular and Respiratory Center, Kumagaya City, Saitama, Japan; 4Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA Background: The purpose of this study was to examine changes in the airway lumen and parenchyma in relation to lung function in patients with chronic obstructive pulmonary disease (COPD) compared with controls. Methods: We studied 70 patients with COPD and 15 normal subjects. Using reconstructed computed tomography (CT) images, we traced the bronchial trees and reconstructed 3 cm circle images around the airways exactly perpendicular to the airway axis at the peripheral, middle, and central zones of the bronchi. We measured the number of airways and vessels, the airway inner diameter, and the area of emphysema in the circles, and analyzed the relationship of these image parameters to lung function. Results: Reduced airway numbers and increased upper lobe emphysema were observed even in early spirometric stages in patients with COPD compared with controls. Other findings included decreased airway inner diameter in advanced spirometric stages. The numbers of peripheral zone bronchi, the extent of the middle zone emphysematous area, and the mean airway inner diameter of the airways were the best predictors of spirometric parameters. A portion of the airways in patients with COPD showed a loss of airway patency at middle or central zone bronchi predominantly in the late spirometric stages. Lumen-obliterated bronchial trees could be traced into emphysematous areas showing air trapping. Conclusion: Compared with controls, our CT observations in patients with COPD showed that airway lumen and lung parenchyma changes along airways differed by spirometric stage, and these changes were associated with decreased lung function. A portion of CT-identified emphysema in patients with COPD appeared to be due to lumen-obliterated airways in the bronchial tree. Keywords: airway dimension, computed tomography, emphysema, pulmonary functions