Asthma is a chronic disease in which social life is altered. The importance of restrictions on social life may be greater in severe asthma or when symptoms are not adequately controlled. General scales of quality-of-life (QOL) may be used to detect the importance of social life impairment, but it is not yet known whether the scores of such QOL measures are reliable and valid in asthmatic patients. A study was carried out in 252 patients with asthma of variable severity (FEV1 ranging from 25 to 131% of predicted) to assess the validity of a general QOL scale, the first French version of the SF-36 health status questionnaire (SF-36). This is based on 36 items selected to represent nine health concepts (physical, social, and role functioning; mental health; health perceptions; energy or fatigue; pain; and general health). All nine SF-36 category scores were highly significantly correlated with the severity of asthma assessed by the clinical score of Aas (p < 0.0007 to p < 0.0001). Eight SF-36 category scores were highly significantly correlated with FEV1 (p < 0.003 to p < 0.0001). A high internal reliability of SF-36 was found using the alpha coefficient of Cronbach (0.91 for the whole questionnaire). The SF-36 questionnaire is valid and reliable in asthma and can therefore be used to examine QOL in asthmatic and nonasthmatic patients and to determine to what extent asthma impairs social life.

Airways remodelling is a feature of longstanding asthma, but may differ in persons with allergic and nonallergic asthma. To assess airways remodelling indirectly, we compared permanent CT-scan abnormalities in 70 subjects with allergic (median age: 30 yr) and 56 with nonallergic asthma (median age: 54.5 yr) who had had asthma of similar duration. None of the subjects were smokers. Asthma severity was assessed by Aas score and FEV1. Permanent high-resolution computed tomographic (HR-CT) scan abnormalities were characterized. In comparison with allergic asthmatic subjects, those with nonallergic asthma had a significantly greater frequency of cylindric (p < 0.0007, Mann-Whitney U test) and varicose (p < 0.004) bronchiectasis, emphysema (p < 0.0003), bronchial recruitment (p < 0.0001), and sequellar linear shadows (p < 0.0001). There was a significant correlation between Aas score and emphysema (p < 0.0001 for nonallergic and p < 0.0005 for allergic asthma; Kendall's test method) or Aas score and sequellar linear shadows (p < 0.007, nonallergic asthma). There was a significant increase in the extent of permanent abnormalities with increasing severity and duration of asthma in both groups. Patients with brittle asthma had few permanent abnormalities. This study confirms that after a similar course of the disease, patients with nonallergic asthma have a more extensive remodelling of the airways than those with allergic asthma.

HLA-DR and ICAM-I molecules play an important role in cellular interactions, and their expression can be induced by inflammatory stimuli. We evaluated the spontaneous expression of HLA-DR and ICAM-1 on epithelial cells obtained by bronchial brushing from 27 asthmatic patients, 10 chronic bronchitis (CB) patients, and 19 normal subjects. In all cases > 90% pure epithelial cells were obtained. HLA-DR and ICAM-1 were characterized using monoclonal antibodies and revealed by immunocytochemistry (APAAP technique). In asthma, the percentage of cells expressing HLA-DR and ICAM-1 was significantly increased by comparison with normal values (p < 0.001) and GB (p < 0.001; HLA-DR; p < 0.003; ICAM-1) and was correlated with the clinical score of Aas (p < 0.001, HLA-DR; p < 0.001, ICAM-1) and the FEV1 (p < 0.001, HLA-DR; p < 0.002; ICAM-1). In CB, expression of both markers was slightly but significantly increased by comparison with normal subjects and was correlated with FEV1 (p < 0.02, HLA-DR; p < 0.03, ICAM-1). In addition, the expression of HLA-DR and ICAM-1 was significantly correlated. This study suggests that epithelial cells are in an activated state in asthma and that the extent of expression of these markers may be specific to asthma, not a general feature of chronic inflammation.

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