Asthma and lower airway diseasePeripheral lung function in patients with stable and unstable asthma
Section snippets
Subject selection: Asthma exacerbation group
The study was approved by the Alfred Hospital Ethics Committee. Consecutive patients with a severe exacerbation of asthma were recruited on admission to the emergency department at the Alfred Hospital, Melbourne, Australia. Patients were included if their admission peak flow readings were less than 50% of their previously obtained personal best value and did not reach 80% or more of their personal best value after bronchodilator and corticosteroid treatment. Inclusion required a hospital length
Results
Thirty-seven asthmatic patients were studied, including 18 patients admitted acutely to the hospital with an exacerbation of asthma and 19 subjects with stable asthma. Demographics and pulmonary function data are shown in Table I. Even though the asthma exacerbation group had a peak expiratory flow of less than 50% of their personal best value at admission, there was some degree of recovery by the time the patients were tested in the laboratory (within 48 hours). The median peak expiratory flow
Discussion
The most important finding of the present study is the association of FEV1 with Sacin values but not with Scond values within cohorts of patients with an exacerbation of asthma and stable asthma. These data confirm our hypothesis that the function of the acinus is an important determinant of FEV1 in asthmatic patients. In the patients with an asthma exacerbation, there was also an association between Sacin values and GINA step scores. There was no association between Scond values and FEV1 or
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2019, The Lancet Respiratory MedicineCitation Excerpt :We recognise that a quality check of our approach to attain an optimal phase 3 slope in the MBNW test27 is key to the validity of our measurements, which we have carefully ensured in the present study. The finding that some Sacin values were in the normal range does not contrast with the presence of airway dysfunction in clinical SAD group 1, since most previous studies21,28–34 on ventilation heterogeneity in adult asthma show a variable contribution of conducting versus acinar lung regions to treatment response, and consistency in the reversibility towards normal values after exacerbations.28 Specifically, the persistent disturbance of ventilation in conducting airways (Scond) appears to be related to airway remodelling, exacerbations, and hyperresponsiveness, whereas the reversible disturbance in acinar airway ventilation (Sacin) mainly reflects asthma severity.35
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Support for this study was provided by the Cooperative Research Centre for Asthma and Airways and the National Health and Medical Research Council, Australia.
Disclosure of potential conflict of interest: B. R. Thompson, M. J. Ellis, V. J. Kelly, R. E. O'Hehir, and S. Verbanck have received grants from the National Health and Medical Research Council and the Cooperative Research Centre for Asthma and Airways. J. A. Douglass has received grants from the National Health and Medical Research Council and the Cooperative Research Centre for Asthma and Airways; is on an advisory board for Novartis; has received payment for lectures from AstraZeneca, GlaxoSmithKline, and Novartis; and has received royalties from Health Press Limited. G. G. King has received grants from the National Health and Medical Research Council, GlaxoSmithKline, Boehringer Ingelheim, Pharmaxis, and the Asthma Foundation; has received travel support from GlaxoSmithKline, Novartis, AstraZeneca, Boehringer Ingelheim, and Pfizer; has received subject payments for clinical trials from Pharmaxis; and is part of a consultancy agreement between GlaxoSmithKline, Novartis, AstraZeneca, Boehringer Ingelheim, Pfizer, and the Woolcock Institute of Medical Research, and his research group receives an unrestricted allocation as part of the monies received from the consultancy agreements.