BACKGROUND: Severe exacerbations of asthma are periods of excess functional and pathological changes in the airways that have been proposed to induce airway remodeling. OBJECTIVE: The objective of this study was to explore whether severe exacerbations are correlated with the decline in post-bronchodilator forced expiratory volume in 1 second (FEV1) and loss of bronchodilator reversibility (BDR). METHODS: We examined the changes in FEV1 and BDR in 140 nonsmoking patients with well-controlled asthma at baseline and correlated these changes with the frequency of severe asthma exacerbations. RESULTS: A 3-year follow-up assessment was completed in 128 patients. A total of 28 (21.9%) patients experienced at least 1 severe exacerbation with a mean rate of 0.16 year(-1). The exacerbation rate was significantly correlated with an annual rate of decline in FEV1 (ρ = 0.49, P < .0001). Both patients with 1 exacerbation and those with 2 or more exacerbations had greater declines in FEV1 than patients with no exacerbations (no exacerbation, 13.6 mL/year; 1 exacerbation, 41.3 mL/year; 2 or more exacerbations, 58.3 mL/year; P < .01 and P < .0001, respectively). The changes in BDR from baseline to the end of the study in patients who did or did not experience an exacerbation were -1.2% and 0.1%, respectively (P < .0005). The changes in BDR were significantly correlated with the annual rates of change in FEV1 (r = 0.40, P < .0001). CONCLUSION: The occurrence of severe exacerbations of asthma is correlated with the progression of irreversible airflow limitation over time. This suggests that asthma exacerbations could have the long-term adverse consequences of structural and functional changes in the airways.
BACKGROUND: Severe exacerbations of asthma are periods of excess functional and pathological changes in the airways that have been proposed to induce airway remodeling. OBJECTIVE: The objective of this study was to explore whether severe exacerbations are correlated with the decline in post-bronchodilator forced expiratory volume in 1 second (FEV1) and loss of bronchodilator reversibility (BDR). METHODS: We examined the changes in FEV1 and BDR in 140 nonsmoking patients with well-controlled asthma at baseline and correlated these changes with the frequency of severe asthma exacerbations. RESULTS: A 3-year follow-up assessment was completed in 128 patients. A total of 28 (21.9%) patients experienced at least 1 severe exacerbation with a mean rate of 0.16 year(-1). The exacerbation rate was significantly correlated with an annual rate of decline in FEV1 (ρ = 0.49, P < .0001). Both patients with 1 exacerbation and those with 2 or more exacerbations had greater declines in FEV1 than patients with no exacerbations (no exacerbation, 13.6 mL/year; 1 exacerbation, 41.3 mL/year; 2 or more exacerbations, 58.3 mL/year; P < .01 and P < .0001, respectively). The changes in BDR from baseline to the end of the study in patients who did or did not experience an exacerbation were -1.2% and 0.1%, respectively (P < .0005). The changes in BDR were significantly correlated with the annual rates of change in FEV1 (r = 0.40, P < .0001). CONCLUSION: The occurrence of severe exacerbations of asthma is correlated with the progression of irreversible airflow limitation over time. This suggests that asthma exacerbations could have the long-term adverse consequences of structural and functional changes in the airways.
Authors: James G Krings; Charles W Goss; Daphne Lew; Maanasi Samant; Mary Clare McGregor; Jonathan Boomer; Leonard B Bacharier; Ajay Sheshadri; Chase Hall; Joshua Brownell; Ken B Schechtman; Samuel Peterson; Stephen McEleney; David T Mauger; John V Fahy; Sean B Fain; Loren C Denlinger; Elliot Israel; George Washko; Eric Hoffman; Sally E Wenzel; Mario Castro Journal: J Allergy Clin Immunol Date: 2021-02-09 Impact factor: 14.290
Authors: Amr S Albanna; Abdulqader K Atiah; Saeed M Alamoudi; Osama M Khojah; Rakan S Alajmi; Albara A Dabroom Journal: J Taibah Univ Med Sci Date: 2021-08-09
Authors: David B Price; Eran Gefen; Gokul Gopalan; Cristiana Miglio; Rosie McDonald; Vicky Thomas; Simon Wan Yau Ming Journal: Pragmat Obs Res Date: 2017-05-18