Are we overlooking persistent small airways dysfunction in community-managed asthma?
Abstract Background Whether small airways dysfunction persists in patients with asthma receiving standard community treatment is unknown. Impulse oscillometry (IOS) is a sensitive measure of small airways function. Objective To assess the degree of small airways dysfunction in a cross-section of pat...
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| Veröffentlicht in: | Annals of allergy, asthma, & immunology asthma, & immunology, 2012-09, Vol.109 (3), p.185-189.e2 |
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| creator | Anderson, William J., MBChB Zajda, Emma, BSc Lipworth, Brian J., MD |
| description | Abstract Background Whether small airways dysfunction persists in patients with asthma receiving standard community treatment is unknown. Impulse oscillometry (IOS) is a sensitive measure of small airways function. Objective To assess the degree of small airways dysfunction in a cross-section of patients with community-managed asthma. Methods We analyzed primary care referral data from patients with persistent asthma ( n = 378) receiving standard community therapy, screened using spirometry and IOS. We compared patients by British Thoracic Society asthma treatment step (2–4). Results Step 2 patients were not different from step 3 patients receiving long-acting beta-agonist (LABA). Step 4 patients differed from step 2 by: higher inhaled corticosteroid (ICS) dose ( P < .0001); lower forced expiratory volume in 1 second (FEV1 %; P = .02) and forced mid-expiratory flow (FEF25–75% ; P = .001); higher frequency of resonance (Fres ; P = .02) and peripheral airway resistance (R5-R20; P = .006); whereas for steps 3 vs 4 there were differences in Fres ( P < .05) and R5-R20 ( P = .006). There were high proportions of abnormality for R5-R20 (>0.03 kPa/L/s) at steps 2, 3, and 4, respectively: 64.6%, 63.5%, and 69.9%. Step 2 patients receiving extra-fine particle ICS demonstrated lower total airway resistance at 5Hz (R5) vs patients receiving standard ICS (124.1% vs 138.3%, P < .05), with no difference in FEV1 . At step 4, R5 remained elevated at 141.3% despite concomitant LABA, with only 2.4% using extra-fine ICS. Conclusion Persistent small airways dysfunction occurs despite treatment at steps 2 through 4 of current asthma guidelines. Extra-fine ICS may reduce airway resistance at step 2. Prospective studies with extra-fine ICS ± LABA at steps 2 through 4 are required to discern whether improving small airways function might result in long-term improved control. |
| doi_str_mv | 10.1016/j.anai.2012.06.022 |
| format | Article |
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Impulse oscillometry (IOS) is a sensitive measure of small airways function. Objective To assess the degree of small airways dysfunction in a cross-section of patients with community-managed asthma. Methods We analyzed primary care referral data from patients with persistent asthma ( n = 378) receiving standard community therapy, screened using spirometry and IOS. We compared patients by British Thoracic Society asthma treatment step (2–4). Results Step 2 patients were not different from step 3 patients receiving long-acting beta-agonist (LABA). Step 4 patients differed from step 2 by: higher inhaled corticosteroid (ICS) dose ( P < .0001); lower forced expiratory volume in 1 second (FEV1 %; P = .02) and forced mid-expiratory flow (FEF25–75% ; P = .001); higher frequency of resonance (Fres ; P = .02) and peripheral airway resistance (R5-R20; P = .006); whereas for steps 3 vs 4 there were differences in Fres ( P < .05) and R5-R20 ( P = .006). There were high proportions of abnormality for R5-R20 (>0.03 kPa/L/s) at steps 2, 3, and 4, respectively: 64.6%, 63.5%, and 69.9%. Step 2 patients receiving extra-fine particle ICS demonstrated lower total airway resistance at 5Hz (R5) vs patients receiving standard ICS (124.1% vs 138.3%, P < .05), with no difference in FEV1 . At step 4, R5 remained elevated at 141.3% despite concomitant LABA, with only 2.4% using extra-fine ICS. Conclusion Persistent small airways dysfunction occurs despite treatment at steps 2 through 4 of current asthma guidelines. Extra-fine ICS may reduce airway resistance at step 2. Prospective studies with extra-fine ICS ± LABA at steps 2 through 4 are required to discern whether improving small airways function might result in long-term improved control.</description><identifier>ISSN: 1081-1206</identifier><identifier>EISSN: 1534-4436</identifier><identifier>DOI: 10.1016/j.anai.2012.06.022</identifier><identifier>PMID: 22920073</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject><![CDATA[Administration, Inhalation ; Adrenal Cortex Hormones - administration & dosage ; Adrenal Cortex Hormones - therapeutic use ; Adult ; Airway Resistance - drug effects ; Albuterol - administration & dosage ; Albuterol - analogs & derivatives ; Albuterol - therapeutic use ; Allergy and Immunology ; Androstadienes - administration & dosage ; Androstadienes - therapeutic use ; Anti-Asthmatic Agents - administration & dosage ; Anti-Asthmatic Agents - therapeutic use ; Asthma - drug therapy ; Asthma - physiopathology ; Beclomethasone - administration & dosage ; Beclomethasone - therapeutic use ; Biological and medical sciences ; Bronchodilator Agents - administration & dosage ; Bronchodilator Agents - therapeutic use ; Chronic obstructive pulmonary disease, asthma ; Dermatology ; Drug Combinations ; Female ; Fluticasone-Salmeterol Drug Combination ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Humans ; Male ; Medical sciences ; Middle Aged ; Oscillometry - methods ; Pneumology ; Respiratory Function Tests ; Respiratory System - physiopathology ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis ; Spirometry - methods]]></subject><ispartof>Annals of allergy, asthma, & immunology, 2012-09, Vol.109 (3), p.185-189.e2</ispartof><rights>American College of Allergy, Asthma & Immunology</rights><rights>2012 American College of Allergy, Asthma & Immunology</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-5a70d0931f3a6fd53f30205e9bfec307e5bf4f49bc0ed50e4e5df72a61435b043</citedby><cites>FETCH-LOGICAL-c441t-5a70d0931f3a6fd53f30205e9bfec307e5bf4f49bc0ed50e4e5df72a61435b043</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1081120612004723$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26350588$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22920073$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Anderson, William J., MBChB</creatorcontrib><creatorcontrib>Zajda, Emma, BSc</creatorcontrib><creatorcontrib>Lipworth, Brian J., MD</creatorcontrib><title>Are we overlooking persistent small airways dysfunction in community-managed asthma?</title><title>Annals of allergy, asthma, & immunology</title><addtitle>Ann Allergy Asthma Immunol</addtitle><description>Abstract Background Whether small airways dysfunction persists in patients with asthma receiving standard community treatment is unknown. Impulse oscillometry (IOS) is a sensitive measure of small airways function. Objective To assess the degree of small airways dysfunction in a cross-section of patients with community-managed asthma. Methods We analyzed primary care referral data from patients with persistent asthma ( n = 378) receiving standard community therapy, screened using spirometry and IOS. We compared patients by British Thoracic Society asthma treatment step (2–4). Results Step 2 patients were not different from step 3 patients receiving long-acting beta-agonist (LABA). Step 4 patients differed from step 2 by: higher inhaled corticosteroid (ICS) dose ( P < .0001); lower forced expiratory volume in 1 second (FEV1 %; P = .02) and forced mid-expiratory flow (FEF25–75% ; P = .001); higher frequency of resonance (Fres ; P = .02) and peripheral airway resistance (R5-R20; P = .006); whereas for steps 3 vs 4 there were differences in Fres ( P < .05) and R5-R20 ( P = .006). There were high proportions of abnormality for R5-R20 (>0.03 kPa/L/s) at steps 2, 3, and 4, respectively: 64.6%, 63.5%, and 69.9%. Step 2 patients receiving extra-fine particle ICS demonstrated lower total airway resistance at 5Hz (R5) vs patients receiving standard ICS (124.1% vs 138.3%, P < .05), with no difference in FEV1 . At step 4, R5 remained elevated at 141.3% despite concomitant LABA, with only 2.4% using extra-fine ICS. Conclusion Persistent small airways dysfunction occurs despite treatment at steps 2 through 4 of current asthma guidelines. Extra-fine ICS may reduce airway resistance at step 2. Prospective studies with extra-fine ICS ± LABA at steps 2 through 4 are required to discern whether improving small airways function might result in long-term improved control.</description><subject>Administration, Inhalation</subject><subject>Adrenal Cortex Hormones - administration & dosage</subject><subject>Adrenal Cortex Hormones - therapeutic use</subject><subject>Adult</subject><subject>Airway Resistance - drug effects</subject><subject>Albuterol - administration & dosage</subject><subject>Albuterol - analogs & derivatives</subject><subject>Albuterol - therapeutic use</subject><subject>Allergy and Immunology</subject><subject>Androstadienes - administration & dosage</subject><subject>Androstadienes - therapeutic use</subject><subject>Anti-Asthmatic Agents - administration & dosage</subject><subject>Anti-Asthmatic Agents - therapeutic use</subject><subject>Asthma - drug therapy</subject><subject>Asthma - physiopathology</subject><subject>Beclomethasone - administration & dosage</subject><subject>Beclomethasone - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Bronchodilator Agents - administration & dosage</subject><subject>Bronchodilator Agents - therapeutic use</subject><subject>Chronic obstructive pulmonary disease, asthma</subject><subject>Dermatology</subject><subject>Drug Combinations</subject><subject>Female</subject><subject>Fluticasone-Salmeterol Drug Combination</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Oscillometry - methods</subject><subject>Pneumology</subject><subject>Respiratory Function Tests</subject><subject>Respiratory System - physiopathology</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</subject><subject>Spirometry - methods</subject><issn>1081-1206</issn><issn>1534-4436</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1v1DAQhiMEoqXwBzigXJC4JIy_kl0JUVUVBaRKHChny3HGxdvEXjxJq_x7HO0WJA4cRp7D845HzxTFawY1A9a839UmGF9zYLyGpgbOnxSnTAlZSSmap7mHDasYh-akeEG0AwC2acTz4oTzLQdoxWlxc5GwfMAy3mMaYrzz4bbcYyJPE4appNEMQ2l8ejALlf1Cbg528jGUPpQ2juMc_LRUY17kFvvS0PRzNOcvi2fODISvju9Z8ePq083ll-r62-evlxfXlZWSTZUyLfSwFcwJ07heCSeAg8Jt59AKaFF1Tjq57SxgrwAlqt613DRMCtWBFGfFu8PcfYq_ZqRJj54sDoMJGGfSDIRSgkm2ovyA2hSJEjq9T340acmQXm3qnV5t6tWmhkZnmzn05jh_7kbs_0Qe9WXg7REwZM3gkgnW01-uEQrUZpO5DwcOs417j0mT9Rgs9j6hnXQf_f_3-PhP3A4--PzjHS5IuzinkD1rpiln9Pf17uvZc4FsuRC_AWbWqD4</recordid><startdate>20120901</startdate><enddate>20120901</enddate><creator>Anderson, William J., MBChB</creator><creator>Zajda, Emma, BSc</creator><creator>Lipworth, Brian J., MD</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120901</creationdate><title>Are we overlooking persistent small airways dysfunction in community-managed asthma?</title><author>Anderson, William J., MBChB ; Zajda, Emma, BSc ; Lipworth, Brian J., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-5a70d0931f3a6fd53f30205e9bfec307e5bf4f49bc0ed50e4e5df72a61435b043</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Administration, Inhalation</topic><topic>Adrenal Cortex Hormones - administration & dosage</topic><topic>Adrenal Cortex Hormones - therapeutic use</topic><topic>Adult</topic><topic>Airway Resistance - drug effects</topic><topic>Albuterol - administration & dosage</topic><topic>Albuterol - analogs & derivatives</topic><topic>Albuterol - therapeutic use</topic><topic>Allergy and Immunology</topic><topic>Androstadienes - administration & dosage</topic><topic>Androstadienes - therapeutic use</topic><topic>Anti-Asthmatic Agents - administration & dosage</topic><topic>Anti-Asthmatic Agents - therapeutic use</topic><topic>Asthma - drug therapy</topic><topic>Asthma - physiopathology</topic><topic>Beclomethasone - administration & dosage</topic><topic>Beclomethasone - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Bronchodilator Agents - administration & dosage</topic><topic>Bronchodilator Agents - therapeutic use</topic><topic>Chronic obstructive pulmonary disease, asthma</topic><topic>Dermatology</topic><topic>Drug Combinations</topic><topic>Female</topic><topic>Fluticasone-Salmeterol Drug Combination</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Fundamental immunology</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Oscillometry - methods</topic><topic>Pneumology</topic><topic>Respiratory Function Tests</topic><topic>Respiratory System - physiopathology</topic><topic>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</topic><topic>Spirometry - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Anderson, William J., MBChB</creatorcontrib><creatorcontrib>Zajda, Emma, BSc</creatorcontrib><creatorcontrib>Lipworth, Brian J., MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of allergy, asthma, & immunology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Anderson, William J., MBChB</au><au>Zajda, Emma, BSc</au><au>Lipworth, Brian J., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Are we overlooking persistent small airways dysfunction in community-managed asthma?</atitle><jtitle>Annals of allergy, asthma, & immunology</jtitle><addtitle>Ann Allergy Asthma Immunol</addtitle><date>2012-09-01</date><risdate>2012</risdate><volume>109</volume><issue>3</issue><spage>185</spage><epage>189.e2</epage><pages>185-189.e2</pages><issn>1081-1206</issn><eissn>1534-4436</eissn><abstract>Abstract Background Whether small airways dysfunction persists in patients with asthma receiving standard community treatment is unknown. Impulse oscillometry (IOS) is a sensitive measure of small airways function. Objective To assess the degree of small airways dysfunction in a cross-section of patients with community-managed asthma. Methods We analyzed primary care referral data from patients with persistent asthma ( n = 378) receiving standard community therapy, screened using spirometry and IOS. We compared patients by British Thoracic Society asthma treatment step (2–4). Results Step 2 patients were not different from step 3 patients receiving long-acting beta-agonist (LABA). Step 4 patients differed from step 2 by: higher inhaled corticosteroid (ICS) dose ( P < .0001); lower forced expiratory volume in 1 second (FEV1 %; P = .02) and forced mid-expiratory flow (FEF25–75% ; P = .001); higher frequency of resonance (Fres ; P = .02) and peripheral airway resistance (R5-R20; P = .006); whereas for steps 3 vs 4 there were differences in Fres ( P < .05) and R5-R20 ( P = .006). There were high proportions of abnormality for R5-R20 (>0.03 kPa/L/s) at steps 2, 3, and 4, respectively: 64.6%, 63.5%, and 69.9%. Step 2 patients receiving extra-fine particle ICS demonstrated lower total airway resistance at 5Hz (R5) vs patients receiving standard ICS (124.1% vs 138.3%, P < .05), with no difference in FEV1 . At step 4, R5 remained elevated at 141.3% despite concomitant LABA, with only 2.4% using extra-fine ICS. Conclusion Persistent small airways dysfunction occurs despite treatment at steps 2 through 4 of current asthma guidelines. Extra-fine ICS may reduce airway resistance at step 2. Prospective studies with extra-fine ICS ± LABA at steps 2 through 4 are required to discern whether improving small airways function might result in long-term improved control.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>22920073</pmid><doi>10.1016/j.anai.2012.06.022</doi><tpages>5</tpages></addata></record> |
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| ispartof | Annals of allergy, asthma, & immunology, 2012-09, Vol.109 (3), p.185-189.e2 |
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| subjects | Administration, Inhalation Adrenal Cortex Hormones - administration & dosage Adrenal Cortex Hormones - therapeutic use Adult Airway Resistance - drug effects Albuterol - administration & dosage Albuterol - analogs & derivatives Albuterol - therapeutic use Allergy and Immunology Androstadienes - administration & dosage Androstadienes - therapeutic use Anti-Asthmatic Agents - administration & dosage Anti-Asthmatic Agents - therapeutic use Asthma - drug therapy Asthma - physiopathology Beclomethasone - administration & dosage Beclomethasone - therapeutic use Biological and medical sciences Bronchodilator Agents - administration & dosage Bronchodilator Agents - therapeutic use Chronic obstructive pulmonary disease, asthma Dermatology Drug Combinations Female Fluticasone-Salmeterol Drug Combination Fundamental and applied biological sciences. Psychology Fundamental immunology Humans Male Medical sciences Middle Aged Oscillometry - methods Pneumology Respiratory Function Tests Respiratory System - physiopathology Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Spirometry - methods |
| title | Are we overlooking persistent small airways dysfunction in community-managed asthma? |
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