Clinical characteristics of adult asthma associated with small airway dysfunction

Kjellberg, Sanna; Houltz, Birgitta; Zetterström, Olle; Robinson, Paul D.; Gustafsson, Per

doi:10.1016/j.rmed.2016.05.028

Cited by 64 publications

(72 citation statements)

References 43 publications

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“…Allergic asthma, here defined as asthma (according to criteria) in combination with sensitization to aeroallergens, was characterized by atopic heredity, eosinophilic inflammation, and small airway dysfunction. A small airway asthma subtype characterized by low FEV 1 and high blood eosinophils has previously been suggested in adults by Kjellberg et al Our data show that a similar pattern can be found in adolescence.…”

Section: Discussionsupporting

confidence: 86%

“…In their study, airway function was assessed via ventilation distribution measured by multiple‐breath washout, and after bronchoprovocation, making comparisons difficult . We do however acknowledge that IOS reflects the mechanics of the peripheral airways with preference to the better functioning units, and might therefore not be as sensitive as methods such as multiple‐breath washout, where weight is given to relatively poorly ventilated lung units . Nevertheless, the finding in the current study that FVC was lower than expected in the asthma group with sensitization is indirectly giving further support to the presence of peripheral airway involvement.…”

Section: Discussionmentioning

confidence: 62%

“…Given that spirometry does not adequately reflect peripheral airway function, measuring further aspects of lung function beyond spirometry could contribute to the understanding of the interplay between asthma and its comorbidities. Impulse oscillometry (IOS) is a non‐invasive method that provides information on the resistance and reactance of the peripheral airways, and has been used to described the peripheral airway engagement in asthma in both children and adults …”

Section: Introductionmentioning

confidence: 99%

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Impact of IgE sensitization and rhinitis on inflammatory biomarkers and lung function in adolescents with and without asthma

Hallberg

Ballardini

Almqvist

et al. 2018

Pediatric Allergy Immunology

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Background Both allergic and non‐allergic rhinitis are associated with worse asthma control. However, it is unclear how IgE sensitization and/or rhinitis are associated with lung function. We therefore evaluated the effect of rhinitis and sensitization on lung function, including the periphery of the airway system, and inflammatory biomarkers in individuals with and without asthma. Methods Participants in the BAMSE longitudinal birth cohort study underwent measures of spirometry, impulse oscillometry, and FeNO at age 16 years. Questionnaires were used to obtain data on asthma and rhinitis. Blood samples were analyzed for eosinophils and allergen‐specific IgE. Results Groups based on the combination of asthma, rhinitis, and sensitization were compared to a healthy reference group. Lower FEV1/FVC levels were seen for groups with asthma only (adjusted mean difference −2.8% units (95% CI −4.7; −1.0), P < 0.01), asthma with sensitization (−2.0 (−3.9; −0.2), P < 0.05), and asthma with sensitization and rhinitis (−2.5 (−3.6; −1.4), P < 0.001). The index of peripheral airway resistance R5–20 was higher in groups with asthma and sensitization (adjusted median difference 94.9 Pa L−1 s−1 (95% CI 60.4; 129.3), P < 0.001), as well as asthma with sensitization and rhinitis (36.9(15.0; 58.8), P < 0.01). These groups also had increased FeNO and blood eosinophil levels. Conclusions We found signs of peripheral airway obstruction and increased levels of inflammatory biomarkers in the presence of allergic asthma, irrespective of rhinitis status. Despite having a reduced FEV1/FVC, peripheral airway engagement was not seen in non‐sensitized adolescents with asthma. We suggest that small airway disease is a feature related to the eosinophilic inflammation in allergic asthma in adolescence.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of IgE sensitization and rhinitis on inflammatory biomarkers and lung function in adolescents with and without asthma

Hallberg

Ballardini

Almqvist

et al. 2018

Pediatric Allergy Immunology

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“…Outcomes calculated were lung clearance index (LCI), functional residual capacity (FRC) and concentration normalized phase III slope (Sn III ) indices S cond and S acin (both corrected for expired tidal volume, i.e. This software served as the template for the commercial Spiroware software used with Exhalyzer â D. A healthy cohort of 400 subjects aged 17-71 years, recruited via the Swedish population register generated reference data for N 2 MBW outcomes, for further details see online supplement (OLS) to reference (Kjellberg et al, 2016). Data were analysed offline using in-house software based on a commercial software package (TestPoint â , Capital Equipment; Billerica, MA, USA), also used for analyses of previous N 2 MBW data (Kjellberg et al, 2016).…”

Section: Lung Function Testsmentioning

confidence: 99%

Utility of single versus multiple breath washout in adult asthma

Kjellberg

Viklund

Robinson

et al. 2018

Clin Physio Funct Imaging

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Nitrogen multiple breath washout (N MBW) is a sensitive method to identify peripheral airway involvement in asthma, but is a time-consuming test. The N vital capacity single breath (VC SBW) test offers greater time efficiency, but concordance with N MBW is poorly understood. The prevalence of peripheral airway abnormality was determined by N MBW and N SBW tests in 194 asthmatic subjects aged 18-1 years. N MBW data were related to findings in 400 healthy controls, aged 17-71 years, while N SBW data were compared to findings in 224 healthy controls, aged 15-65 years, to derive equipment-specific reference values. Amongst asthmatic subjects, relationships between N SBW and N MBW outcomes were studied. N SBW relationship with clinical history, spirometry, blood eosinophils and fraction exhaled nitric oxide (FENO) data was also explored. The prevalence of peripheral airway involvement (i.e. abnormal ventilation distribution) determined by N SBW-derived phase III slope (N S ) was 24·7%, compared to 44% determined by N MBW-derived lung clearance index (LCI) (P<0·001). Predictors of abnormal N S were older age, smoking history and lower FEV N SBW offers lower sensitivity than N MBW to detect small airway dysfunction in adult asthma, but may be a marker of more severe disease.

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“…Higher LCI values reflect greater ventilation inhomogeneity and thus worse lung disease. Limited data suggest that LCI is elevated in school-age children and adults with asthma13 even when spirometry is in the normal range 14–16. To our knowledge, there are no studies of LCI in a clinical cohort of infants with recurrent wheezing (RW) disorders.…”

Section: Introductionmentioning

confidence: 99%