Mustafa Abdo1, Frederik Trinkmann2, Anne-Marie Kirsten3, Frauke Pedersen4, Christian Herzmann5, Erika von Mutius6, Matthias V Kopp7, Gesine Hansen8, Benjamin Waschki9, Klaus F Rabe10, Henrik Watz3, Thomas Bahmer11. 1. LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany. Electronic address: m.abdo@lungenclinic.de. 2. Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany; Department of Biomedical Informatics, Heinrich-Lanz-Center, University Medical Center Mannheim, Mannheim, Germany. 3. Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany. 4. LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany; Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany. 5. Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, Germany. 6. Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany. 7. Division of Pediatric Pulmonology and Allergology, University Children's Hospital, Luebeck, Germany, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Luebeck, Germany. 8. Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research (DZL), Hannover, Germany. 9. LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany. 10. LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany. 11. LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany; University Hospital Schleswig-Holstein-Campus Kiel, Department for Internal Medicine I, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Kiel, Germany.
Abstract
BACKGROUND: Little is known about the role of small airway dysfunction (SAD) and its complex relationship with asthma control and physical activity (PA). OBJECTIVE: to investigate the interrelationship between SAD, risk factors of asthma severity, symptom control and PA. METHODS: We assessed SAD by impulse oscillometry and other sophisticated lung function measures including inert gas washout in adults with asthma (mild to moderate, n=140; severe, n=128) and 69 healthy controls from the ALLIANCE cohort. We evaluated SAD prevalence and its interrelation with risk factors of asthma severity (older age, obesity, smoking), type-2 inflammation (sputum and blood eosinophils, FeNO), systemic inflammation (hsCRP), asthma control (AC) and physical activity (PA, accelerometer for one week). We applied a clinical model based on Structural Equation Modeling (SEM) that integrated causal pathways between these clinical variables. RESULTS: The prevalence of SAD ranged from 75% to 90% in patients with severe asthma and from 53% to 64% in mild to moderate asthma. Severe SAD was associated with poor AC and low PA. SEM indicated that age, obesity, obesity related systemic inflammation, T2-inflammation and smoking are independent predictors of SAD. SAD was the main determinant factor of AC, which in turn affected PA. Obesity affected AC directly and through its contribution to SAD and low PA. In addition, PA had bi-directional associations with obesity, SAD and AC. SEM also indicated an interrelation between distal airflow limitation, air trapping and ventilation heterogeneity. CONCLUSION: SAD is a highly prevalent key feature of asthma that interrelates a spectrum of distal lung function abnormalities with risk factors of asthma severity, asthma control and physical activity.
BACKGROUND: Little is known about the role of small airway dysfunction (SAD) and its complex relationship with asthma control and physical activity (PA). OBJECTIVE: to investigate the interrelationship between SAD, risk factors of asthma severity, symptom control and PA. METHODS: We assessed SAD by impulse oscillometry and other sophisticated lung function measures including inert gas washout in adults with asthma (mild to moderate, n=140; severe, n=128) and 69 healthy controls from the ALLIANCE cohort. We evaluated SAD prevalence and its interrelation with risk factors of asthma severity (older age, obesity, smoking), type-2 inflammation (sputum and blood eosinophils, FeNO), systemic inflammation (hsCRP), asthma control (AC) and physical activity (PA, accelerometer for one week). We applied a clinical model based on Structural Equation Modeling (SEM) that integrated causal pathways between these clinical variables. RESULTS: The prevalence of SAD ranged from 75% to 90% in patients with severe asthma and from 53% to 64% in mild to moderate asthma. Severe SAD was associated with poor AC and low PA. SEM indicated that age, obesity, obesity related systemic inflammation, T2-inflammation and smoking are independent predictors of SAD. SAD was the main determinant factor of AC, which in turn affected PA. Obesity affected AC directly and through its contribution to SAD and low PA. In addition, PA had bi-directional associations with obesity, SAD and AC. SEM also indicated an interrelation between distal airflow limitation, air trapping and ventilation heterogeneity. CONCLUSION: SAD is a highly prevalent key feature of asthma that interrelates a spectrum of distal lung function abnormalities with risk factors of asthma severity, asthma control and physical activity.
Authors: Marcello Cottini; Carlo Lombardi; Giovanni Passalacqua; Diego Bagnasco; Alvise Berti; Pasquale Comberiati; Gianluca Imeri; Massimo Landi; Enrico Heffler Journal: Front Med (Lausanne) Date: 2022-05-23
Authors: Bingrong Zhao; Lu Bai; Rongjun Wan; Yanan Wang; Ling Qin; Qiming Xiao; Pinhua Pan; Chengping Hu; Juan Jiang Journal: Front Public Health Date: 2022-07-20
Authors: Thomas Bahmer; Henrik Watz; Mustafa Abdo; Frederik Trinkmann; Anne-Marie Kirsten; Heike Biller; Frauke Pedersen; Benjamin Waschki; Erika Von Mutius; Matthias Kopp; Gesine Hansen; Klaus F Rabe Journal: J Asthma Allergy Date: 2021-07-13