Airways Obstruction in Patients With Long-term Asthma Consistent With Irreversible Asthma

• Published in: Chest Vol. 112; no. 5; pp. 1234 - 1240
• Main Authors: Backman, Kenneth S., Greenberger, Paul A., Patterson, Roy
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.11.1997; American College of Chest Physicians; Elsevier B.V
• Subjects: Adult; Airway Obstruction - drug therapy; Airway Obstruction - etiology; Airway Obstruction - physiopathology; Allergies; Asthma; Asthma - complications; Asthma - drug therapy; Asthma - physiopathology; Biological and medical sciences; Bronchitis; Chronic obstructive pulmonary disease, asthma; Complications and side effects; Development and progression; Disease; Dose-Response Relationship, Drug; Drug Administration Routes; end-stage asthma; Glucocorticoids - administration & dosage; Glucocorticoids - therapeutic use; Humans; Hypersensitivity - complications; Hypersensitivity - diagnosis; Hypersensitivity - drug therapy; Immunology; irreversible obstruction; Lung diseases, Obstructive; Medical records; Medical sciences; Middle Aged; Patients; Pneumology; Predictive Value of Tests; Prednisone - administration & dosage; Prednisone - therapeutic use; Respiratory Function Tests; Retrospective Studies; Risk Factors; Skin Tests; Steroids; Time Factors; end-stage asthma; irreversible obstruction; Lung volume; Human; Respiratory disease; Forced vital capacity; Evolution; Exploration; Obstructive pulmonary disease; Maximal expiratory volume per second; Long term; Asthma
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.112.5.1234

Objective: To describe a series of eight patients with long-term asthma and pulmonary function consistent with “end-stage,” irreversible obstruction. Design: Retrospective descriptive analysis of patients with severe asthma. Setting: A university-based allergy-immunology service with a large population of corticosteroid-dependent patients with asthma. Patients: Eight patients with long-standing asthma and apparently irreversible airways obstruction despite long-term oral and inhaled corticosteroid therapy. Measurements: Pulmonary function data, radiographic studies including chest radiograph and high-resolution CT of the chest, and serologic analysis to rule out allergic bronchopulmonary aspergillosis and α1-antitrypsin deficiency had been performed as indicated, and these results were obtained through chart review. Results: The age of the patients ranged from 41 to 58 years, with a mean duration of asthma of 39 years (SD = 12.4 years). No patient had evidence of any other pulmonary disease process. The mean duration of daily or alternate-day oral corticosteroid treatment was 15.8 years (SD = 11.8 years). Despite intensive pharmacotherapy, all patients had an FEV1 57%; (42±12%;) with marked small airways disease as reflected in the forced expiratory flow between 25%; and 75%; of the FVC. Three of the eight patients demonstrated an accelerated decline in FEV1 despite continuous systemic corticosteroids. Conclusions: We have described a series of eight patients with long-standing asthma who demonstrate irreversible airways obstruction despite long-term systemic and inhaled corticosteroids. The term “end-stage asthma” or irreversible asthma might be applied to these patients in whom fixed obstruction has occurred in the absence of other pulmonary diseases.