A 10 year follow up of 180 adults with bronchial asthma: factors important for the decline in lung function.

Abstract

Background Little is known about the factors that determine outcome in asthma. The purpose of this study was to describe the relation of various factors of potential importance to the rate of decline in lung function in adults with intrinsic and extrinsic asthma. Methods Of 180 asthmatic patients, 143 (79%) participated in a 10 year follow up examination. At the time of enrolment all patients underwent certain tests for asthma (case history, total IgE, skinprick tests, the radioallergosorbent test (RAST), histamine release from basophil leucocytes, and specific bronchial provocations). On the basis of these tests 94 patients had intrinsic asthma and 49 extrinsic asthma. Results Patients with intrinsic asthma had an annual decline in FEV, of 50 ml, whereas those with extrinsic asthma had a decline of 22 5 ml; the rate of decline of lung function increased with increasing age in both groups. An inverse relation between initial FEV, and decline in FEV, (the "horse racing effect") was found for the patients with extrinsic asthma but not for the patients with intrinsic asthma. There was no relation between rate of decline in lung function and number of cigarettes smoked. A high degree of airway variability-that is, reversibility in FEV1-at the time of enrolment was found to be associated with a steeper decline in lung function in patients with intrinsic asthma, whereas increasing degrees of obstruction

New concepts for expressing forced expiratory volume in 1 s arising from survival analysis

“…For never-smokers aged .50 yrs the annual FEV1 decline has been estimated to be 28 mL in males and 22 mL in females [22], giving a female to male ratio of 0.78, which is approximately the same as the ratio of a female to male 1st percentile FEV1 of 0.8. In patients with asthma, FEV1 decline has been found to be ,50 mL?yr -1 in intrinsic asthmatics and ,23 mL?yr -1 in extrinsic asthmatics [23], and ,32 mL?yr -1 in asthmatic nonsmokers aged 40-60 yrs and ,26 mL?yr -1 in those aged .60 yrs [21]. None of these studies suggested that this loss was a proportional effect.…”

Different Severity and Severity Predictors in Early-Onset and Late-Onset Asthma: A Taiwanese Population-Based Study

“…Similarly, in several clinic-based studies which evaluated the severity of asthma in relation to age at onset by spirometry, later onset of asthma was a risk factor of persistent airflow limitation [1], low lung function [2] and rapid decline of lung function [3]. In a longitudinal study, airflow limitation and the response to bronchodilator of asthmatics diagnosed at ages of 16-22 years were lower compared with the younger age groups [17].…”

“…Previous clinic-based studies have shown that patients with late-onset asthma have persistent airflow limitation [1], low lung function [2] and rapid decline of lung function [3]. In a phenotype classification study [4], late-onset asthma has been associated with less atopy and more severe asthma.…”

The persistence of allergen exposure favors pulmonary function decline in workers with allergic occupational asthma

“…It has been widely demonstrated that smoking habits enhance lung function decline in asthmatic subjects (Ulrik et al 1992;Dijkstra et al 2006). In our study, there were no current smokers; however, a signiWcant greater lung function decline was observed in those asthmatic who were exsmokers and who underwent persistent allergen exposure.…”