scholarly journals Lung function in adults with stable but severe asthma: air trapping and incomplete reversal of obstruction with bronchodilation

2008 ◽  
Vol 104 (2) ◽  
pp. 394-403 ◽  
Author(s):  
Ronald L. Sorkness ◽  
Eugene R. Bleecker ◽  
William W. Busse ◽  
William J. Calhoun ◽  
Mario Castro ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Severe Asthma ◽  
Forced Expiratory Volume ◽  
Pathological Process ◽  
Airflow Limitation ◽  
Care Utilization ◽  
Air Trapping ◽  
Asthma Phenotype ◽  
Blood Institute ◽  
National Heart Lung

Five to ten percent of asthma cases are poorly controlled chronically and refractory to treatment, and these severe cases account for disproportionate asthma-associated morbidity, mortality, and health care utilization. While persons with severe asthma tend to have more airway obstruction, it is not known whether they represent the severe tail of a unimodal asthma population, or a severe asthma phenotype. We hypothesized that severe asthma has a characteristic physiology of airway obstruction, and we evaluated spirometry, lung volumes, and reversibility during a stable interval in 287 severe and 382 nonsevere asthma subjects from the National Heart, Lung, and Blood Institute Severe Asthma Research Program. We partitioned airway obstruction into components of air trapping [indicated by forced vital capacity (FVC)] and airflow limitation [indicated by forced expiratory volume in 1 s (FEV1)/FVC]. Severe asthma had prominent air trapping, evident as reduced FVC over the entire range of FEV1/FVC. This pattern was confirmed with measures of residual lung volume/total lung capacity (TLC) in a subgroup. In contrast, nonsevere asthma did not exhibit prominent air trapping, even at FEV1/FVC <75% predicted. Air trapping also was associated with increases in TLC and functional reserve capacity. After maximal bronchodilation, FEV1 reversed similarly from baseline in severe and nonsevere asthma, but the severe asthma classification was an independent predictor of residual reduction in FEV1 after maximal bronchodilation. An increase in FVC accounted for most of the reversal of FEV1 when baseline FEV1 was <60% predicted. We conclude that air trapping is a characteristic feature of the severe asthma population, suggesting that there is a pathological process associated with severe asthma that makes airways more vulnerable to this component.

scholarly journals Pharmacological Rationale for Targeting IL-17 in Asthma

2021 ◽  
Vol 2 ◽  
Author(s):  
Siti Farah Rahmawati ◽  
Maurice te Velde ◽  
Huib A. M. Kerstjens ◽  
Alexander S. S. Dömling ◽  
Matthew Robert Groves ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Inhaled Corticosteroids ◽  
Current Knowledge ◽  
Experimental Models ◽  
Airflow Limitation ◽  
Interleukin 17 ◽  
Asthma Phenotype ◽  
T Helper 2 ◽  
Bronchial Biopsies

Asthma is a respiratory disease that currently affects around 300 million people worldwide and is defined by coughing, shortness of breath, wheezing, mucus overproduction, chest tightness, and expiratory airflow limitation. Increased levels of interleukin 17 (IL-17) have been observed in sputum, nasal and bronchial biopsies, and serum of patients with asthma compared to healthy controls. Patients with higher levels of IL-17 have a more severe asthma phenotype. Biologics are available for T helper 2 (Th2)-high asthmatics, but the Th17-high subpopulation has a relatively low response to these treatments, rendering it a rather severe asthma phenotype to treat. Several experimental models suggest that targeting the IL-17 pathway may be beneficial in asthma. Moreover, as increased activation of the Th17/IL-17 axis is correlated with reduced inhaled corticosteroids (ICS) sensitivity, targeting the IL-17 pathway might reverse ICS unresponsiveness. In this review, we present and discuss the current knowledge on the role of IL-17 in asthma and its interaction with the Th2 pathway, focusing on the rationale for therapeutic targeting of the IL-17 pathway.

scholarly journals Predictors of reversible airway obstruction with omalizumab in severe asthma: a real-life study

2019 ◽  
Vol 13 ◽  
pp. 175346661984127 ◽  
Author(s):  
Paolo Solidoro ◽  
Filippo Patrucco ◽  
Francesca de Blasio ◽  
Luisa Brussino ◽  
Michela Bellocchia ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Allergic Asthma ◽  
Severe Asthma ◽  
Airway Remodeling ◽  
Real Life ◽  
Forced Expiratory Volume ◽  
Life Study ◽  
Reversible Airway Obstruction ◽  
Number Of Patients ◽  
Severe Allergic Asthma

Background: Omalizumab may modulate airway remodeling in severe asthma. Using forced expiratory volume in 1 second (FEV1) as a surrogate of airway remodeling, we aimed to investigate if an omalizumab add-on in severe allergic asthma may lead to a persistent reversal of airway obstruction and to evaluate the potential biomarkers of airway obstruction reversibility. Methods: Data were collected before (T0) and after omalizumab add-on for 1 year (T1, 32 patients), 2 years (T2, 26 patients) and 4 years (T4, 13 patients). All patients had baseline FEV1 below 80 % predicted (60.5 ± 12.5 %). After omalizumab, 18 patients showed FEV1 normalization (reversible airway obstruction; RAO+) already at T1 (88.7 ± 14.9 %, p < 0.0001) that persisted up to T4 (83.2 ± 7.9, p < 0.01), while 14 patients (RAO−) had FEV1 persistently decreased, from T1 (65.2 ± 8.4%, p < 0.05) up to T4 (61.4 ± 6.2%, not significant). Both groups had significant improvement of symptoms and exacerbations after omalizumab at T1, which persisted up to T4. The comparison between pretreatment characteristics of the two groups showed that RAO+ patients, had higher values of circulating eosinophils, exhaled nitric oxide (FENO), prevalence of rhinitis and nasal polyps, need of oral corticosteroids, shorter asthma duration, higher FEV1 and response to albuterol test. The optimal cut-off points predicting FEV1 normalization after omalizumab add-on were 30.5 ppb for FENO and 305 cells/µl for eosinophils. Conclusions: This study suggests that omalizumab add-on contributes to the persistent reversal of airway obstruction in a consistent number of patients with severe allergic asthma, and this beneficial effect is predicted by elevated pretreatment FENO and circulating eosinophils.

scholarly journals Sex dependence of airflow limitation and air trapping in children with severe asthma

2011 ◽  
Vol 127 (4) ◽  
pp. 1073-1074 ◽  
Author(s):  
Ronald L. Sorkness ◽  
W. Gerald Teague ◽  
Madhuri Penugonda ◽  
Anne M. Fitzpatrick
Keyword(s):  
Severe Asthma ◽  
Airflow Limitation ◽  
Air Trapping

scholarly journals Plasma P-Selectin Is Inversely Associated with Lung Function and Corticosteroid Responsiveness in Asthma

2020 ◽  
Vol 181 (11) ◽  
pp. 879-887
Author(s):  
Mats W. Johansson ◽  
Brandon M. Grill ◽  
Karina T. Barretto ◽  
Molly C. Favour ◽  
Hazel M. Schira ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Severe Asthma ◽  
Total Lung Capacity ◽  
Forced Expiratory Volume ◽  
Residual Volume ◽  
Air Trapping ◽  
Lung Capacity ◽  
University Of Wisconsin ◽  
Multiple Phenotypes ◽  
The University

<b><i>Background:</i></b> Severe asthma has multiple phenotypes for which biomarkers are still being defined. Plasma P-selectin reports endothelial and/or platelet activation. <b><i>Objective:</i></b> To determine if P-selectin is associated with features of asthma in a longitudinal study. <b><i>Methods:</i></b> Plasmas from 70 adult patients enrolled in the Severe Asthma Research Program (SARP) III at the University of Wisconsin-Madison were analyzed for concentration of P-selectin at several points over the course of 3 years, namely, at baseline (BPS), after intramuscular triamcinolone acetonide (TA) injection, and at 36 months after baseline. Thirty-four participants also came in during acute exacerbation and 6 weeks after exacerbation. <b><i>Results:</i></b> BPS correlated inversely with forced expiratory volume in 1 s (FEV<sub>1</sub>) and with residual volume/total lung capacity, an indicator of air trapping. BPS was inversely associated with FEV<sub>1</sub> change after TA, by regression analysis. FEV<sub>1</sub> did not change significantly after TA if BPS was above the median, whereas patients with BPS below the median had significantly increased FEV<sub>1</sub> after TA. BPS was higher in and predicted assignment to SARP phenotype cluster 5 (“severe fixed-airflow asthma”). P-selectin was modestly but significantly increased at exacerbation but returned to baseline within 3 years. <b><i>Conclusions:</i></b> High BPS is associated with airway obstruction, air trapping, the “severe fixed-airflow” cluster, and lack of FEV<sub>1</sub> improvement in response to TA injection. P-selectin concentration, which is a stable trait with only modest elevation during exacerbation, may be a useful biomarker for a severe asthma pheno- or endotype characterized by low pulmonary function and lack of corticosteroid responsiveness.

Correlation of FEV1/FEV6 with BODE Index, CAT Score and DLCO in COPD Patients

2020 ◽  
Vol 4 (2) ◽  
pp. 18-23
Author(s):  
Zechariah Jebakumar Arulanantham
Keyword(s):  
Airway Obstruction ◽  
Care Facility ◽  
Health Care Facility ◽  
Cost Effective ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Handheld Device ◽  
Bode Index

Chronic Obstructive Pulmonary Disease is associated with progressive airflow limitation. Spirometry is one of the most important non-invasive tests that help in diagnosing airway obstruction. A Post bronchodilator FEV1/FVC ratio < 0.7 according to GOLD guidelines is considered to be diagnostic of COPD, wherein FEV1 is the forced expiratory volume in the first second, and FVC is the forced vital capacity which requires complete emptying of lungs that may require longer expiratory time and a more significant expiratory effort. The value of FEV1/FEV6 ratio is similar to the FEV1/FVC rate in diagnosing obstruction. FEV1/FEV6 is one such spirometric measurement which reduces the effort of expiration and helps in detecting the airway obstruction at the end of the sixth second during forceful exhalation thus serving as a natural, cost-effective bedside investigation that can be used in every health care facility for prompt diagnosis and management of the disease. FEV1/FEV6 can also be used to assess the prognosis of patients with COPD. It can even independently predict the reduction of lung function, rate of death and risk of carcinoma. The vitalograph is a smooth handheld device which helps in early detection of COPD in a quick, simple and reproducible manner. It not only displays the FEV1, FEV6 ratio and FEV1 per cent predicted but also provided information regarding the severity of COPD classification and lung age estimation. It can be used as a tool to avoid over diagnosis of COPD, especially in elderly patients. It has the advantage of requiring minimal instruction for use by non-respiratory specialists as well. This work concludes that FEV1/FEV6 can be used as a simple, cost-effective bedside investigation to diagnose COPD as an alternative to the conventional spirometry to detect undiagnosed airway obstruction in individuals with a low expiratory effort, especially in poor resource settings.

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