Asthma and irreversible airflow obstruction.

Brown, P J; Greville, Hugh; Finucane, Kevin E.

doi:10.1136/thx.39.2.131

Cited by 289 publications

(194 citation statements)

References 23 publications

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“…Although our study was cross-sectional, rather than longitudinal, our findings suggest that even among well-controlled asthmatic children, ventilation heterogeneity may increase with increasing age. Similar findings were observed with spirometric values for which longitudinal cohort studies suggest worsening airway obstruction with increasing age [24][25][26]. Our findings suggest that LCI may be more sensitive than spirometry for detecting worsening airway function in well-controlled asthmatic children.…”

Section: Discussionsupporting

confidence: 76%

Ventilation Heterogeneity and Airway Hyperreactivity in Children with Well Controlled Asthma

Assaf

Clem²,

Jewett³

et al. 2016

J Pulm Respir Med

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Section: Discussionsupporting

confidence: 76%

Ventilation Heterogeneity and Airway Hyperreactivity in Children with Well Controlled Asthma

Assaf

Clem²,

Jewett³

et al. 2016

J Pulm Respir Med

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“…Evidence from cross-sectional studies of adult asthmatics suggest that the degree of pulmonary function deficit is a function of the duration of previous asthma [4,5,7,8], which appears to be in line with observations concerning an inverse association between duration of respiratory symptoms and response to anti-inflammatory therapy [23± 25]. However, the present longitudinal study did not reveal an association between duration of previous asthma and the presence of NRAO, probably because most of the patients in the study had had asthma for a number of years already at the time of enrolment.…”

Section: Discussionmentioning

confidence: 99%

Nonreversible airflow obstruction in life‐long nonsmokers with moderate to severe asthma

Ulrik¹,

Backer²

1999

Eur Respir J

155

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Nonreversible airflow obstruction in life-long nonsmokers with moderate to severe asthma. C.S. Ulrik, V. Backer. #ERS Journals Ltd 1999. ABSTRACT: The aim of this longitudinal study was to assess the frequency of nonreversible airflow obstruction (NRAO) among adults with moderate to severe asthma, and to compare the decline of forced expiratory volume in one second (FEV1) in asthmatics with reversible and nonreversible airflow obstruction.Ninety-two (31 males) life-long nonsmokers with asthma participated in a 10-yr follow-up study; mean age 37 yrs (range 18±64) and duration of asthma 16 yrs (range 2±60) at enrolment. Case history, including use of asthma medication, was obtained, and pulmonary function, including diffusion capacity, was measured using standard techniques. At enrolment, all patients had typical symptoms and reversible airflow obstruction. (NRAO) was defined as FEV1 <80% predicted and change in DFEV1 after 5 mg salbutamol <9% pred.A total of 21 (23%) patients (mean age at enrolment 32 yrs) fulfilled the criteria for NRAO at the time of follow-up; current therapy was inhaled steroids (n=21, mean daily dose 1.5 mg), oral steroids (n=14), theophylline (n=20), oral b 2 -agonist (n=6) and inhaled b 2 -agonist. The patients with NRAO (n=21) had a steeper decline in FEV1 than the remaining patients (n=71, reversible airflow obstruction (RAO)), mean SD 53 23 mL . yr -1 and 36 21 mL . yr -1 , respectively (p<0.003). Increasing degree of bronchodilator reversibility (DFEV1% pred) at enrolment (p=0.002) and long-term treatment with oral corticosteroids (p=0.009) were associated with an increased risk for the presence of NRAO at follow-up. The comparison of data for NRAO and RAO patients (at follow-up) revealed no significant differences in mean values for total diffusion capacity (TL,CO), diffusion constant (KCO), or total lung capacity.The findings suggest that a subgroup of asthmatics may experience very steep rates of decline in forced expiratory volume in one second leading to severe nonreversible airflow obstruction, whereas no indication was found that long-standing asthma may lead to the development of emphysema.

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“…The relationship between airway inflammation and structural change is of interest in asthma. Longstanding asthma is related to fixed airway narrowing [41], and the rapidity of death from an attack of asthma is related not only to inflammatory cell profiles but also to the size of mucous glands [39]. It is assumed that chronic airway inflammation results in structural change.…”

Section: Discussionmentioning

confidence: 99%

The distribution of eosinophils and lymphocytes in the large and small airways of asthmatics

Carroll

Cooke²,

James³

1997

Eur Respir J

246

163

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Airway inflammation in asthma consists of variably increased numbers of mononuclear and polymorphonuclear cells, and there is a growing body of evidence to suggest a primary role for lymphocytes and eosinophils in the pathogenesis of asthma. The aim of this study was to examine the distribution of lymphocytes and eosinophils in the bronchial tree of cases of mild and severe asthma.In cases of fatal asthma (n=10), nonfatal asthma (sudden nonrespiratory death with a history of asthma n=10), and control cases (sudden death with no history of respiratory illness, n=10), lymphocytes and eosinophils were counted in transverse sections of large and small airways stained with haematoxylin and eosin.Cases of fatal asthma had longstanding severe asthma and nonfatal cases generally had mild asthma. Lymphocytes were increased in all airway size groups both in fatal and nonfatal cases of asthma compared to control cases (p<0.001). Eosinophils were increased (p<0.001) in all airway size groups in the cases of fatal asthma compared to the nonfatal asthma and control groups, which were similar. These differences between case groups were of similar magnitude, when only a random single airway section from each case in each size group was examined. The numbers of lymphocytes correlated with the number of eosinophils in the fatal asthma group (r=0.60; p<0.0001), and to a lesser extent in the nonfatal (r=0.34; p=0.001) and control groups (r=0.32; p=0.001).These findings suggest that increased numbers of lymphocytes are uniformly distributed in the large and small airways in cases of asthma, independently of asthma severity, and that eosinophil recruitment may be related to asthma severity. Hence, biopsy specimens of the proximal airways are likely to be representative of the cellular infiltrate in large and small airways in mild and severe asthma.

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Asthma and irreversible airflow obstruction.

Cited by 289 publications

References 23 publications

Ventilation Heterogeneity and Airway Hyperreactivity in Children with Well Controlled Asthma

Ventilation Heterogeneity and Airway Hyperreactivity in Children with Well Controlled Asthma

Nonreversible airflow obstruction in life‐long nonsmokers with moderate to severe asthma

The distribution of eosinophils and lymphocytes in the large and small airways of asthmatics

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