A Novel Air Trapping Segment Score Identifies Opposing Effects of Obesity and Eosinophilia on Air Trapping in Asthma

<b>Rationale:</b> Density thresholds in computed tomography (CT) lung scans quantify air trapping (AT) at the whole-lung level but are not informative for AT in specific bronchopulmonary segments. <b>Objectives:</b> To apply a segment-based measure of AT in asthma to investigate the clinical determinants of AT in asthma. <b>Methods:</b> In each of 19 bronchopulmonary segments in CT lung scans from 199 patients with asthma, AT was categorized as present if lung attenuation was less than -856 Hounsfield units at expiration in ⩾15% of the lung area. The resulting AT segment score (0-19) was related to patient outcomes. <b>Measurements and Main Results:</b> AT varied at the lung segment level and tended to persist at the patient and lung segment levels over 3 years. Patients with widespread AT (⩾10 segments) had more severe asthma (<i>P</i> < 0.05). The mean (±SD) AT segment score in patients with a body mass index ⩾30 kg/m² was lower than in patients with a body mass index <30 kg/m² (3.5 ± 4.6 vs. 5.5 ± 6.3; <i>P</i> = 0.008), and the frequency of AT in lower lobe segments in obese patients was less than in upper and middle lobe segments (35% vs. 46%; <i>P</i> = 0.001). The AT segment score in patients with sputum eosinophils ⩾2% was higher than in patients without sputum eosinophilia (7.0 ± 6.1 vs. 3.3 ± 4.9; <i>P</i> < 0.0001). Lung segments with AT more frequently had airway mucus plugging than lung segments without AT (48% vs. 18%; <i>P</i> ⩽ 0.0001). <b>Conclusions:</b> In patients with asthma, air trapping is more severe in those with airway eosinophilia and mucus plugging, whereas those who are obese have less severe trapping because their lower lobe segments are spared.