A 15-year follow-up study of ventilatory function in adults with asthma.
ABSTRACT Although the prevalence of asthma and morbidity related to asthma are increasing, little is known about the natural history of lung function in adults with this disease.
We used data from a longitudinal epidemiologic study of the general population in a Danish city, the Copenhagen City Heart Study, to analyze changes over time in the forced expiratory volume in one second (FEV1) in adults with self-reported asthma and adults without asthma. The study was conducted between 1976 and 1994; for each patient, three measurements of lung function were obtained over a 15-year period. The final data set consisted of measurements from 17,506 subjects (8136 men and 9370 women), of whom 1095 had asthma.
Among subjects who participated in all three evaluations, the unadjusted decline in FEV1 among subjects with asthma was 38 ml per year, as compared with 22 ml per year in those without asthma. The decline in FEV1 normalized for height (FEV1 divided by the square of the height in meters) was greater among the subjects with asthma than among those without the disease (P<0.001). Among both men and women, and among both smokers and nonsmokers, subjects with asthma had greater declines in FEV1 over time than those without asthma (P<0.001). At the age of 60 years, a 175-cm-tall nonsmoking man without asthma had an average FEV1 of 3.05 liters, as compared with 1.99 liters for a man of similar age and height who smoked and had asthma.
In a sample of the general population, people who identified themselves as having asthma had substantially greater declines in FEV1 over time than those who did not.
SourceAvailable from: Beatriz Tavares[Show abstract] [Hide abstract]
ABSTRACT: Introduction: Despite asthma is classically characterized by reversible airways obstruction, some patients show incomplete responses to bronchodilators. Objective: The aim of this study was to evaluate a group of patients with persistent moderate or severe asthma and the relationship of lung function impairment with anthropometric, clinical and imaging abnormalities. Material and methods: 60 patients were divided in two groups according to bronchial obstruction reversibility criteria (ATS): group 1 (n=27) with reversibility of bronchial obstruction and group 2 (n=33) without reversibility criteria. The relationship of lung functional abnormalities with several parameters was assessed. Results: There was no difference in sex, age, body mass index, atopic status, rhinitis, smoking status or inhalatory occupational risk. The age at onset of disease and its duration was higher in group 2. The inhaled corticotherapy started later and had a shorter duration compared with group 1. A longer duration of inhaled corticotherapy was associated with more frequent bronchial obstruction reversibility (p=0,031). Both groups revealed a great number of patients with imaging abnormalities. In Group 1 the ΔVEMS (%) correlated negatively with the age at onset of disease (rs= -0,626, p<0,0001) and with the age at onset of inhaled corticotherapy (rs= -0,415; p=0,031) and positively with the duration of disease (rs= 0,442; p=0,021). Conclusion: Although the development of irreversible obstructive changes is probably a multifactorial process, the onset of disease at younger ages and the early beginning and maintenance of treatment with inhaled corticosteroid seem the most important factors for a long lasting normal lung function.Revista Portuguesa de Imunoalergologia 01/2007; 15(1):43.
[Show abstract] [Hide abstract]
ABSTRACT: Hypereosinophilic asthma (HEA) is considered as a specific severe asthma phenotype. Whether eosinophils have a link with airway remodeling characterized by pathological (thickening of the basement membrane), functional (persistent airflow impairment and decline in lung function) and imaging features (increase airway wall thickness at CT scan) is still debated. In a one year prospective cohort of 142 severe asthma patients (according to IMI), 14 persistent HEA patients (defined by a persistent blood eosinophilia >500/mm(3) at two consecutive visits) were identified and compared with ten patients without any blood eosinophilia during the follow-up period (NEA, blood eosinophilia always <500/mm(3)). Airflow and lung volumes were recorded. Bronchial biopsies obtained at enrollment were stained for eosinophils (EG2) and basement membrane thickness (BM) was quantified. Imaging by CT scan acquisition was standardized and bronchial abnormalities quantified. ACQ score and exacerbations were prospectively recorded. HEA was not associated with preeminent features of airway remodeling assessed by airflow impairment (Best ever FEV1 values 97% ± 20 in HEA vs. 80 ± 24% in NEA, p = 0.020), decline of FEV1 (FEV1 Decline 40 ± 235 ml/y in HEA vs. 19 ± 40 ml/y in NEA, P = 0.319), submucosal abnormalities (BM thickness 7.80 ± 2.66 μm in HEA vs. 6.84 ± 2.59 in NEA, p = 0.37) and airway wall thickening at CT-scan (0.250 ± 0.036 mm vs. 0.261 ± 0.043, p = 0.92). Eosinophils blood count was inversely correlated with semiquantitative imaging score (rho -0.373, p = 0.039). Smoking history and positive skin prick tests were independent risk factors for increased BM thickening. Outcomes were similar in both populations (Control and exacerbations). Persistent HEA is not associated with evidences of airway remodeling. Copyright © 2014 Elsevier Ltd. All rights reserved.Respiratory Medicine 01/2015; 109(2). DOI:10.1016/j.rmed.2014.12.008 · 2.92 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: The lung epithelium has evolved to serve a number of functions, ranging from gas exchange in the alveolus to the regulation of mucus clearance in the larger conducting airways. The heterogeneous mix of epithelial cell types enables these functions at the different levels of the airway. For example, mucin-producing and secreting goblet cells provide a mucus gel that the multiciliated cells propel in a cephalad direction out of the airways, whereas surfactant-producing type 2 pneumocytes maintain alveolar patency with type 1 pneumocytes enabling gas exchange (Rackley and Stripp, 2012). A greater understanding of the pathways that regulate the function of the epithelium as well as those which define repair and remodeling in both health and disease will be integral to our identification of therapeutic targets to treat respiratory diseases such as severe asthma, cystic fibrosis, and chronic obstructive pulmonary disease (COPD).Cell Reports 12/2014; 13(2). DOI:10.1016/j.celrep.2014.12.017 · 7.21 Impact Factor