Fixed airways obstruction among patients with severe asthma: findings from the Singapore General Hospital-Severe Asthma Phenotype Study

BMC Pulmonary Medicine

Mariko Siyue Koh¹  Therese Sophie Lapperre¹  Keng Leong Tan¹  Gan Liang Tan¹  Anthony Chau Ang Yii¹ 

[1] Department of Respiratory and Critical Care Medicine, Singapore General Hospital, 20 College Road, Singapore 169856, Singapore

关键词: Air trapping;    Smoking;    Severe asthma;    Fixed airways obstruction;   

Others  :  1091055
DOI  :  10.1186/1471-2466-14-191

 received in 2014-05-07, accepted in 2014-11-27,  发布年份 2014

【 摘 要 】

Background

A subset of severe asthma patients has fixed airways obstruction, which is characterized by incomplete reversibility to bronchodilator challenge. We aimed to elucidate the factors associated with fixed airways obstruction in a cohort of patients with severe asthma in Singapore.

Methods

245 patients from the Singapore General Hospital-Severe Asthma Phenotype Study (SGH-SAPS) were screened. These patients fulfilled World Health Organization criteria for "treatment-resistant severe asthma" and were all on combination of high-dose inhaled corticosteroids and long-acting beta2 agonists. 76 patients had pre- and postbronchodilator lung function tests and were selected for analysis. They were divided into two groups based on postbronchodilator (Post BD) forced expiratory volume in one second, PostBDFEV₁ % predicted: ≥70% (Non-Fixed Obs) and < 70% (Fixed Obs). We compared clinical and demographic parameters between the two groups.

Results

Patients in the Fixed Obs group were more frequently past or current smokers and had a higher pack-year smoking history. Overall, pack-year smoking history had a modest negative correlation with PostBDFEV₁ % predicted. Atopy, allergen sensitization (type and numbers), comorbidities, symptoms, health care utilization and medication use did not differ between the two groups. The prebronchodilator FEV₁ % predicted, FEV₁/FVC and FVC % predicted were significantly lower in the Fixed Obs group. In addition, prebronchodilator FVC % predicted accounted for more variability than FEV₁/FVC in predicting PostBDFEV₁% predicted.

Conclusion

Smoking is associated with fixed airways obstruction in patients with treatment-resistant severe asthma in Singapore. Furthermore, our results suggest that both small and large airways obstruction contribute independently to fixed airways obstruction in severe asthma.

【 授权许可】

   
2014 Yii et al.; licensee BioMed Central Ltd.

【 图 表 】

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