Small Airway Impairment and Bronchial Hyperresponsiveness in Asthma Onset

Sposato, Bruno; Scalese, Marco; Migliorini, Maria Giovanna; Tomassi, M. Di; Scala, Raffaele

doi:10.4168/aair.2014.6.3.242

Cited by 25 publications

(23 citation statements)

References 45 publications

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“…Compared to the CVID patients without BHR, those with BHR also displayed reduced values for FEV 1 (92 vs. 100%), FEV 1 /FVC (100 vs. 105%) and, interestingly, MEF25 (71.5 vs. 107.8%), implying the predominant impairment of the peripheral airways. This observation corresponds well with findings in pediatric patients with allergic rhinitis and at the time of asthma onset [37, 38]. We have thus confirmed that a decrease in MEF25 is associated with BHR, also in patients with underlying humoral immunodeficiency.…”

Section: Discussionsupporting

confidence: 77%

Bronchial Asthma and Bronchial Hyperresponsiveness and Their Characteristics in Patients with Common Variable Immunodeficiency

Milota

Bloomfield

Paračková

et al. 2018

Int Arch Allergy Immunol

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Background: Common variable immunodeficiency (CVID) is one of the most frequent primary immunodeficiencies and is characterized by disturbed immunoglobulin production and dysregulation of the immune system. Results of previous studies suggest a higher prevalence of bronchial asthma (BA) in CVID patients than in the general population. We initiated this study to evaluate lung functions and identify risk factors for BA and bronchial hyperresponsiveness (BHR) in patients with CVID. Methods: Twenty-three patients with CVID were included in this study. In all of them, spirometry and a metacholine bronchoprovocation test were performed. We also investigated the role of atopy, eosinophilic inflammation, and potential risk factors such as gender, age, or immunoglobulin levels at the time of diagnosis. Results: BHR was confirmed in 12 patients (52%), all of whom had normal FEV₁ and FEV₁/FVC. However, BHR-positive patients had significantly decreased MEF25. BHR-positive patients had also more symptoms related to bronchial obstruction, with 8 of them (35%) being suspected of having BA at the end of the study. A higher prevalence of BHR was found in females, with a relative risk of 2.89. Conclusions: An increased prevalence of BHR and BA was detected in CVID patients compared to the general population. BA may develop despite the disturbed immunoglobulin production, and the majority of patients display nonatopic and noneosinophilic properties. These results suggest a limited role of atopy and eosinophilic inflammation in the pathogenesis of BA in CVID patients.

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Section: Discussionsupporting

confidence: 77%

Bronchial Asthma and Bronchial Hyperresponsiveness and Their Characteristics in Patients with Common Variable Immunodeficiency

Milota

Bloomfield

Paračková

et al. 2018

Int Arch Allergy Immunol

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“…However FEF 25-75% measurements can vary markedly and change in proportion to the FVC. [22][23][24] In addition, abnormalities in mid-range flow measurements during forced exhalation are not specific for small airway disease in individual subjects. 25 Interestingly, all of the subjects with asthma (n ϭ 4, 6.3%) in this study, including 2 subjects with Churg-Strauss syndrome, exhibited a reduced FEF 25-75% .…”

Section: Discussionmentioning

confidence: 99%

Clinical Utility of Additional Measurement of Total Lung Capacity in Diagnosing Obstructive Lung Disease in Subjects With Restrictive Pattern of Spirometry

et al. 2016

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BACKGROUND: Total lung capacity (TLC), forced expiratory flow between 25 and 75% (FEF 25-75% ), peak expiratory flow (PEF), or post-bronchodilator volume response is recommended to detect obstructive abnormalities in the lung. The present study was performed to evaluate the usefulness of these pulmonary function test (PFT) parameters to diagnose obstructive lung disease in subjects with a restrictive pattern of spirometry. METHODS: A retrospective study was conducted in 64 subjects with a restrictive pattern of spirometry (normal FEV 1 /FVC and low FVC) out of 3,030 patients who underwent all pre-and post-bronchodilator spirometry and lung volume measurement between April 2008 and December 2010. After subjects were clinically classified into those with obstructive lung disease, restrictive lung disease, and mixed lung disease, the agreements between the clinical diagnosis and PFT classification according to TLC, FEF 25-75% , PEF, and post-bronchodilator response criteria were compared. RESULTS: Of 64 subjects, 18 (28.1%) were classified with obstructive lung disease, 39 (60.9%) had restrictive lung disease, 1 (1.6%) had mixed lung disease, and 6 (9.4%) had no clinical lung disease. Among the 58 subjects with clinical lung disease, 22 (37.9%), 37 (63.8%), 33 (56.9%), and 3 (5.2%) were classified as having obstructive pattern based on TLC, FEF 25-75% , PEF, and post-bronchodilator response criteria, respectively. The kappa coefficients for the agreement between the clinical classification and PFT classification using TLC, FEF 25-75% , PEF, and post-bronchodilator response criteria in 58 subjects were 0.59, 0.18, 0.17, and < 0.01, respectively. CONCLUSIONS: The additional measurement of TLC is more useful than FEF 25-75% , PEF, and post-bronchodilator response for diagnosis of obstructive lung disease in subjects with a restrictive pattern of spirometry, when obstructive lung disease is clinically suspected.

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“…Asthma patients with no symptoms, normal lung function, can also find obstruction in small airway. FEF 25-75 is generally considered as an approximate measure of the small airways caliber and thus its reduction represents a small airways obstruction caused by asthma inflammation (14). FEF 25-75 percent predicted should be evaluated in clinical studies of asthma in children and might be of use in predicting the presence of clinically relevant reversible airflow obstruction.…”

Section: Asthma In Childrenmentioning

confidence: 99%

Airway hyper-responsiveness and small airway function in children with well-controlled asthma

Huang

Zhang

et al. 2015

Pediatr Res

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Background: Airway hyper-responsiveness (AHR) and small airway function are critical to children with asthma. Little is known about the role of the small airway in well-controlled subjects with AHR. We aimed to evaluate AHR and small airway function in children with well-controlled asthma, and to investigate the association between them. Methods: We studied 116 cases of children with well-controlled asthma (group A), 46 cases healthy children as controls (group C). Spirometry, impulse oscillometry (IOS), and methacholine challenge test (MCT) were conducted on all the children. results: (i) Group A and group C had no differences in forced expiratory volume in 1 s (FEV 1 ) and FEV 1 /forced vital capacity (FVC) ratio (P > 0.05). Forced expiratory flow between 25 and 75% of vital capacity ) and reactance at 5 Hz (X5) in group A were significantly lower than those in group C. (ii) One hundred and five cases (90.5%) of group A proved positive to MCT. (iii) FEF in group A proved positive to MCT but were lower than those proved negative (P < 0.05). conclusion: AHR persisted in majority of children with well-controlled asthma. Among children with well-controlled asthma, small airway function was lower in those with AHR than those without AHR. a sthma is the most common chronic lower respiratory disease in childhood throughout the world. The newest Global Initiative for Asthma guidelines, as well as international consensus on pediatric asthma suggested that, after initial severity assessment, ongoing care should include continual assessment of the patient's asthma control in terms of real-life activities (1,2). This approach uses a cycle of detailed assessment and intervention to achieve and maintain asthma control. The level of control is defined by frequency of asthma symptoms, and the degree of lung function (forced expiratory volume in 1 s (FEV 1 ), peak expiratory flow). But in some cases called "well controlled asthma" with no disease activity and normal lung function, how can we evaluate and manage them? Airway hyper-responsiveness (AHR) is a clinical feature of asthma and is often in proportion to the underlying severity of the disease. AHR of children with well-controlled asthma can display condition of the disease. But, the evaluation of AHR is not popular in pediatric clinic. In areas without this means, how can we do next?Asthma is an inflammatory airway disorder that involves also the small airways (defined as the peripheral membranous bronchioles <2 mm in diameter) (3). Two decades ago, Wagner et al. (4) demonstrated a more than sevenfold increase in small airway resistance in asymptomatic asthma with normal spirometry (FEV 1 and forced vital capacity (FVC)). The contribution of the small airways to the development of the clinical features and functional impairment in asthma is incompletely understood (5). Study suggested that asthmatics with AHR have more severe small airways obstruction, but little is known about the role of the small airways in asymptomatic subjects with AHR. Therefore, the aim of our...

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Small Airway Impairment and Bronchial Hyperresponsiveness in Asthma Onset

Cited by 25 publications

References 45 publications

Bronchial Asthma and Bronchial Hyperresponsiveness and Their Characteristics in Patients with Common Variable Immunodeficiency

Bronchial Asthma and Bronchial Hyperresponsiveness and Their Characteristics in Patients with Common Variable Immunodeficiency

Clinical Utility of Additional Measurement of Total Lung Capacity in Diagnosing Obstructive Lung Disease in Subjects With Restrictive Pattern of Spirometry

Airway hyper-responsiveness and small airway function in children with well-controlled asthma

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