Katrina O Tonga1,2,3,4,5,6, David G Chapman2,7, Claude S Farah2,3,4,8, Brian G Oliver2,7, Sabine C Zimmermann1,2,3,4, Stephen Milne1,2,3,4, Farid Sanai2,3,7, Kanika Jetmalani2, Norbert Berend2,3,6,9, Cindy Thamrin2,3, Gregory G King1,2,3,10. 1. The Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia. 2. Airway Physiology and Imaging Group and the Woolcock Emphysema Centre, The Woolcock Institute of Medical Research, Sydney, NSW, Australia. 3. Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. 4. The Department of Respiratory Medicine, Concord Hospital, Sydney, NSW, Australia. 5. The Department of Thoracic and Lung Transplant Medicine, St Vincent's Hospital, Sydney, NSW, Australia. 6. St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia. 7. Discipline of Medical Sciences, School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia. 8. Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia. 9. Respiratory Research Group, The George Institute for Global Health, Sydney, NSW, Australia. 10. NHMRC Centre of Excellence in Severe Asthma, Newcastle, NSW, Australia.
Abstract
BACKGROUND AND OBJECTIVE: Fixed airflow obstruction (FAO) in asthma occurs despite optimal inhaled treatment and no smoking history, and remains a significant problem, particularly with increasing age and duration of asthma. Increased lung compliance and loss of lung elastic recoil has been observed in older people with asthma, but their link to FAO has not been established. We determined the relationship between abnormal lung elasticity and airflow obstruction in asthma. METHODS: Non-smoking asthmatic subjects aged >40 years, treated with 2 months of high-dose inhaled corticosteroid/long-acting beta-agonist (ICS/LABA), had FAO measured by spirometry, and respiratory system resistance at 5 Hz (Rrs5 ) and respiratory system reactance at 5 Hz (Xrs5 ) measured by forced oscillation technique. Lung compliance (K) and elastic recoil (B/A) were calculated from pressure-volume curves measured by an oesophageal balloon. Linear correlations between K and B/A, and forced expiratory volume in 1 s/forced vital capacity (FEV1 /FVC), Rrs5 and Xrs5 were assessed. RESULTS: Eighteen subjects (11 males; mean ± SD age: 64 ± 8 years, asthma duration: 39 ± 22 years) had moderate FAO measured by spirometry ((mean ± SD z-score) post-bronchodilator FEV1 : -2.2 ± 0.5, FVC: -0.7 ± 1.0, FEV1 /FVC: -2.6 ± 0.7) and by increased Rrs5 (median (IQR) z-score) 2.7 (1.9 to 3.2) and decreased Xrs5 : -4.1(-2.4 to -7.3). Lung compliance (K) was increased in 9 of 18 subjects and lung elastic recoil (B/A) reduced in 5 of 18 subjects. FEV1 /FVC correlated negatively with K (rs = -0.60, P = 0.008) and Rrs5 correlated negatively with B/A (rs = -0.52, P = 0.026), independent of age. Xrs5 did not correlate with lung elasticity indices. CONCLUSION: Increased lung compliance and loss of elastic recoil relate to airflow obstruction in older non-smoking asthmatic subjects, independent of ageing. Thus, structural lung tissue changes may contribute to persistent, steroid-resistant airflow obstruction. CLINICAL TRIAL REGISTRATION: ACTRN126150000985583 at anzctr.org.au (UTN: U1111-1156-2795).
BACKGROUND AND OBJECTIVE: Fixed airflow obstruction (FAO) in asthma occurs despite optimal inhaled treatment and no smoking history, and remains a significant problem, particularly with increasing age and duration of asthma. Increased lung compliance and loss of lung elastic recoil has been observed in older people with asthma, but their link to FAO has not been established. We determined the relationship between abnormal lung elasticity and airflow obstruction in asthma. METHODS: Non-smoking asthmatic subjects aged >40 years, treated with 2 months of high-dose inhaled corticosteroid/long-acting beta-agonist (ICS/LABA), had FAO measured by spirometry, and respiratory system resistance at 5 Hz (Rrs5 ) and respiratory system reactance at 5 Hz (Xrs5 ) measured by forced oscillation technique. Lung compliance (K) and elastic recoil (B/A) were calculated from pressure-volume curves measured by an oesophageal balloon. Linear correlations between K and B/A, and forced expiratory volume in 1 s/forced vital capacity (FEV1 /FVC), Rrs5 and Xrs5 were assessed. RESULTS: Eighteen subjects (11 males; mean ± SD age: 64 ± 8 years, asthma duration: 39 ± 22 years) had moderate FAO measured by spirometry ((mean ± SD z-score) post-bronchodilator FEV1 : -2.2 ± 0.5, FVC: -0.7 ± 1.0, FEV1 /FVC: -2.6 ± 0.7) and by increased Rrs5 (median (IQR) z-score) 2.7 (1.9 to 3.2) and decreased Xrs5 : -4.1(-2.4 to -7.3). Lung compliance (K) was increased in 9 of 18 subjects and lung elastic recoil (B/A) reduced in 5 of 18 subjects. FEV1 /FVC correlated negatively with K (rs = -0.60, P = 0.008) and Rrs5 correlated negatively with B/A (rs = -0.52, P = 0.026), independent of age. Xrs5 did not correlate with lung elasticity indices. CONCLUSION: Increased lung compliance and loss of elastic recoil relate to airflow obstruction in older non-smoking asthmatic subjects, independent of ageing. Thus, structural lung tissue changes may contribute to persistent, steroid-resistant airflow obstruction. CLINICAL TRIAL REGISTRATION: ACTRN126150000985583 at anzctr.org.au (UTN: U1111-1156-2795).
Authors: Alberto Papi; Dave Singh; J Christian Virchow; G Walter Canonica; Andrea Vele; George Georges Journal: Clin Transl Allergy Date: 2022-04-17 Impact factor: 5.657
Authors: Katherine E Menson; Madeleine M Mank; Leah F Reed; Camille J Walton; Katherine E Van Der Vliet; Jennifer L Ather; David G Chapman; Bradford J Smith; Mercedes Rincon; Matthew E Poynter Journal: Am J Physiol Lung Cell Mol Physiol Date: 2020-08-12 Impact factor: 5.464
Authors: Giancarlo Pesce; Kai Triebner; Diana A van der Plaat; Dominique Courbon; Steinar Hustad; Torben Sigsgaard; Dennis Nowak; Joachim Heinrich; Josep M Anto; Sandra Dorado-Arenas; Jesús Martinez-Moratalla; Jose A Gullon-Blanco; José L Sanchez-Ramos; Chantal Raherison; Isabelle Pin; Pascal Demoly; Thorarinn Gislason; Kjell Torén; Bertil Forsberg; Eva Lindberg; Elisabeth Zemp; Rain Jogi; Nicole Probst-Hensch; Shyamali C Dharmage; Debbie Jarvis; Judith Garcia-Aymerich; Alessandro Marcon; Francisco Gómez-Real; Bénédicte Leynaert Journal: EClinicalMedicine Date: 2020-06-06
Authors: Sandra Rutting; Dia Xenaki; Karosham D Reddy; Melissa Baraket; David G Chapman; Gregory G King; Brian G Oliver; Katrina O Tonga Journal: ERJ Open Res Date: 2021-05-31