Smoking Status Modifies the Relationship between Th2 Biomarkers and Small Airway Obstruction in Asthma

Background. Cigarette smoking and Th2-inflammation are both crucial in the pathogenesis of asthma. However, it is unknown whether smoking can affect the association between Th2-inflammation and small airway obstruction in adults with asthma. Methods. Adults diagnosed with asthma by a pulmonologist according to Global Initiative for Asthma guidelines were recruited from September 2016 to April 2018 to participate in this study. Participants were divided into two groups, the small airway obstruction group (those with FEF25–75% predicted value ≤ 65%) and the normal small airway function group (those with FEF25–75% predicted value > 65%). Final data analysis included 385 and 93 people in the Obstructive Group and the Normal Group, respectively. Total serum IgE level and blood eosinophil count were used as biomarkers of the Th2 phenotype. Results. The Obstructive Group had a larger fraction of smokers, higher blood eosinophil count, and lower lung function than the Normal Group. Current-smoking status was associated with an increased risk of small airway obstruction (adjusted odds ratio = 4.677, 95% confidence interval [1.593–13.730]); and log-IgE level was associated with a decreased risk of small airway obstruction (0.403 [0.216–0.754]). Smoking status stratified analysis showed an association between log-IgE level and a decreased risk of small airway obstruction only in never-smoker asthmatics (0.487 [0.249–0.954]). Conclusions. Current-smoking status and total serum IgE are, respectively, associated with small airway obstruction. Smoking status modifies the relationship between Th2 biomarkers and small airway function. These findings contribute to the understanding of risk factors associated with asthma endotyping.

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AB0597 PULMONARY FUNCTION IN PATIENTS DIAGNOSED OF EARLY SYSTEMIC SCLEROSIS: A NEW TOOL FOR SYSTEMIC SCLEROSIS CLASIFFICATION?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4423 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1595.1-1595

Author(s):

F. M. Ortiz Sanjuan ◽

C. Pávez Perales ◽

E. Vicens Bernabeu ◽

C. Alcañiz Escandell ◽

I. Cánovas Olmos ◽

...

Keyword(s):

Systemic Sclerosis ◽

Pulmonary Function ◽

Airway Obstruction ◽

Pulmonary Involvement ◽

Classification Criteria ◽

Small Airway ◽

University Hospital ◽

Ventilatory Pattern ◽

Small Airway Obstruction

Background:Interstitial lung disease (ILD) is a frequent complication of systemic sclerosis (SSc) and is often progressive and has a poor prognosis. A restrictive ventilatory defect could suggest ILD either alone or in combination with pulmonary arterial hypertension.Nowadays, Early-SSc is well defined as preliminary stage of SSc. Patients who meet criteria for Early-SSc could benefit from an early diagnosis of pulmonary involvement.Objectives:Our aim was to assess the pulmonary function in patients diagnosed of Early SSc.Methods:Retrospective observational study of a wide and unselected series of patients diagnosed as Early-SSc from a single university hospital from 2012 to 2019. Patients were classified as Early-SSc following Le Roy criteria. Despite this, patients already did not meet 2013 ACR/EULAR classification criteria for SSc. We reviewed pulmonary function through conventional spirometry and diffusing capacity of lung for carbon monoxide (DLCO).Results:We included 56 patients with a mean age of 52.3±12.1 years (96.4% women; 3.6% men).At the diagnosis of Early-SSc, no one of our patients evidenced a restrictive ventilatory pattern. DLCO was below normal limits in 18 patients (32.1%). Small airway obstruction expressed according decreased maximal (mid-) expiratory flow (MMEF) 25-75 was present in 24 patients (42.8%).After a mean follow-up period of 38.3±2.4 months, 29 (51.8%) patients fulfilled 2013 ACR/EULAR criteria. The average time between diagnosis of Early-SSc and achieve SSc classification was 24.4±1.8 months. The remaining 27 patients continued classified as Early-SSc.An analysis of the subgroup of patients which progressed to SSc showed that DLCO was decreased in 15 of those 29 patients (51.7%) and 18 of 29 patients (62.1%) presented decreased MMEF 25-75. Comparing with the subgroup of patients which not progressed to SSc were significant differences (Decreased DLCO: 51.7% vs 11.1%; p=0.02 and decreased MMEF 25-75: 42.8% vs 22.2%; p=0.05).The analysis of pulmonary function of the subgroup of patients continued classified as Early-SSc after follow-up period did not show significative changes after follow-up.Conclusion:In our study, a third of the patients classified as Early-SSc presented at diagnosis abnormal values of DLCO and/or signs of small airway obstruction without the presence of a restrictive ventilatory pattern. Moreover, this pulmonary disfunction was significantly more frequent in patients who progressed to definitive SSc. Patients which remains classified as Early-SSc did not experience significative changes.Our results support the concept that pulmonary function was impaired in Early-SSc and that I should probably be considered for future Early-SSc classification criteria.Disclosure of Interests:None declared

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Grading, Time Course, and Incidence of Exercise-Induced nduced Airway Obstruction and Hyperinflation in Asthmatic Children

PEDIATRICS ◽

10.1542/peds.56.5s.868 ◽

1975 ◽

Vol 56 (5s) ◽

pp. 868-879

Author(s):

Gerd J. A. Cropp ◽

I. J. Schmultzler

Keyword(s):

Pulmonary Function ◽

Airway Obstruction ◽

Clinical Status ◽

Small Airway ◽

Strenuous Exercise ◽

Normal Children ◽

Asthmatic Children ◽

Ergometer Exercise ◽

Exercise Induced ◽

Small Airway Obstruction

We evaluated clinical status and pulmonary function in 60 perennially asthmatic and 11 normal children before and repeatedly after incrementally increasing bicycle ergometer exercise. The changes in clinical status and pulmonary function which were elicited by strenuous exercise were graded by an air exchange and a physiological grading system respectively. Normal children showed no significant clinical or physiological changes after exercise. Strenuous exercise elicited significant deteriorations in clinical and physiological measurements in 36% to 77% of asthmatic girls and 46% to 90% of asthmatic boys, the frequency depending on the test used to determine exercise-induced abnormalities. The incidence of exercise-induced asthma (EIA) was statistically significantly higher in asthmatic boys than girls. The higher incidence of EIA in boys was primarily due to a larger number of very severe attacks in boys than girls; mild and moderate EIA was about equally common in the two sexes. Most patients with EIA developed large and small airway obstruction, although large airway obstruction tended to be the predominant and the more severe abnormality. Clinical and physiological abnormalities, regardless of severity, were usually most marked during the first ten minutes after exercise and lessened thereafter. Mild EIA usually lasted for only 15 minutes or less; severe EIA improved, but usually did not resolve within 35 minutes of exercise. There were three patients in whom the severity of EIA got worse after exercise and an additional seven in whom the improvement was minimal. In these ten patients isoproterenol aerosol terminated EIA, indicating that exercise-induced large and small airway obstruction in asthmatic children is primarily. if not solely. due to bronchospasm.

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Evaluation of Glucocorticoid Therapy in Asthma Children with Small Airway Obstruction Based on CT Features of Deep Learning

Computational and Mathematical Methods in Medicine ◽

10.1155/2021/7936548 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Wei Zhang ◽

Yang Wang

Keyword(s):

Deep Learning ◽

Airway Obstruction ◽

Airway Inflammation ◽

Maintenance Treatment ◽

Learning Algorithm ◽

Small Airway ◽

Imaging Features ◽

Ct Image ◽

Deep Learning Algorithm ◽

Small Airway Obstruction

This study was aimed at exploring the treatment of asthma children with small airway obstruction in CT imaging features of deep learning and glucocorticoid. A total of 145 patients meeting the requirements in hospital were included in this study, and they were randomly assigned to receive aerosolized glucocorticoid ( n = 45 ), aerosolized glucocorticoid combined with bronchodilator ( n = 50 ), or oral steroids ( n = 50 ) for 4 weeks after discharge. The lung function and fractional exhaled nitric oxide (FENO) indexes of the three groups were measured, respectively, and then the effective rates were compared to evaluate the clinical efficacy of glucocorticoids with different administration methods and combined medications in the short-term maintenance treatment after acute exacerbation of asthma. Deep learning algorithm was used for CT image segmentation. The CT image is sent to the workbench for processing on the workbench, and then the convolution operation is performed on each input pixel point during the image processing. After 4 weeks of maintenance treatment, FEF50 %, FEF75 %, and MMEF75/25 increased significantly, and FENO decreased significantly ( P < 0.01 ). The improvement results of FEF50 %, FEF75 %, MMEF75/25, and FENO after maintenance treatment were as follows: the oral hormone group was the most effective, followed by the combined atomization inhalation group, and the hormone atomization inhalation group was the least effective. The differences among them were statistically significant ( P < 0.05 ). The accuracy of artificial intelligence segmentation algorithm was 81%. All the hormones were more effective than local medication in the treatment of small airway function and airway inflammation. In the treatment of aerosol inhalation, the hormone combined with bronchiectasis drug was the most effective in improving small airway obstruction and reducing airway inflammation compared with single drug inhalation. Deep learning CT images are simple, noninvasive, and intuitively observe lung changes in asthma with small airway functional obstruction. Asthma with small airway functional obstruction has high clinical diagnosis and evaluation value.

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THU0421 Prevalence and clinical correlates of small airway obstruction in patients with systemic sclerosis

10.1136/annrheumdis-2018-eular.3944 ◽

2018 ◽

Author(s):

P. Ostojic ◽

M. Vujovic ◽

A. Blanka Protic

Keyword(s):

Systemic Sclerosis ◽

Airway Obstruction ◽

Small Airway ◽

Clinical Correlates ◽

Small Airway Obstruction

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Assessment of the effect of non-asthmatic allergic rhinitis on pulmonary functions - A prospective case-control study

10.22541/au.161575558.83122186/v1 ◽

2021 ◽

Author(s):

Ahmed Jalwa ◽

Rahul Magazine ◽

ROHIT SINGH ◽

Shama Shetty

Keyword(s):

Allergic Rhinitis ◽

Pulmonary Function ◽

Airway Obstruction ◽

Small Airway ◽

Significant Difference ◽

Prognostic Importance ◽

Allergic Manifestations ◽

Small Airway Obstruction ◽

Control Study

Introduction Allergic rhinitis, beginning from childhood, is a global health problem. According to the literature, allergic rhinitis has been found to be associated with asthma and other allergic manifestations. In this study we like to find out the significance and prognostic importance of pulmonary function test (PFT) in allergic rhinitis. Design and setting: The study was carried out over a period of 2 years, with 63 cases and controls each. Subjects in the age of 20-55 years with allergic rhinitis and SFAR score of >/=7 were included as a case. Participants were interviewed and sent for PFT. Controls were recruited from the retrospective data of healthy individuals with pulmonary function parameters done for health checkup. These controls had an SFAR score of <7. Main outcome measures: Clinical data and PFT of cases and controls was used for the study. SFAR score was used to recruit the cases and controls. All the data obtained were analyzed and compared between cases and controls. Results The mean age of the cases and controls were 33.17 +/- 10.817 and 44.41 +/- 7.4, respectively. Majority of cases and controls were males (60.3% and 57.1%). A statistically significant difference in FEF25-75% among cases and controls was noted (p=0.00), thus proving probability of developing small airway obstruction in subjects with allergic rhinitis. Conclusion Subjects with allergic rhinitis have a probability of developing small airway obstruction with subclinical changes, hence necessitating the need of regular follow-up.

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