Elsevier

Respiratory Medicine

Volume 102, Issue 10, October 2008, Pages 1473-1482
Respiratory Medicine

The course of persistent airflow limitation in subjects with and without asthma

https://doi.org/10.1016/j.rmed.2008.04.011Get rights and content
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Summary

Rationale

Most patients who develop persistent airflow limitation do so either as a manifestation of chronic obstructive pulmonary disease that is largely related to smoking or as a consequence of persistent asthma. We sought to compare the natural course of lung function associated with persistent airflow limitation in subjects with and without asthma from early to late adult life.

Methods

We studied 2552 participants aged 25 or more who had multiple questionnaire and lung function data from the long-term prospective population-based Tucson Epidemiological Study of Airway Obstructive Disease. Persistent airflow limitation was defined as FEV1/FVC ratio consistently <70% in all completed surveys subsequent to the first survey with airflow limitation. Participants were divided into nine groups based on the combination of their physician-confirmed asthma status (never, onset ≤25 years, or onset >25 years) and the presence of airflow limitation during the study follow-up (never, inconsistent, or persistent).

Results

Among subjects with an asthma onset ≤25 years, blood eosinophilia increased significantly the odds of developing persistent airflow limitation (adjusted ORs: 3.7, 1.4–9.5), whereas cigarette smoking was the strongest risk factor for persistent airflow limitation among non-asthmatics and among subjects with asthma onset after age 25 years. Among subjects with persistent airflow limitation, the natural course of lung function differed between subjects with asthma onset ≤25 years and non-asthmatics, with the former having lower FEV1 levels at age 25 (predicted value for a 175-cm tall male of 3400 versus 4090 ml, respectively; p < 0.001) and the latter having greater FEV1 loss between age 25 and 75 (1590 versus 2140 ml; p = 0.003).

Conclusion

In subjects who have asthma onset before 25 years of age and persistent airflow limitation in adult life, the bulk of the FEV1 deficit is already established before age 25 years.

Keywords

Asthma
COPD
Eosinophilia
Airflow limitation

Cited by (0)

This study was funded in part by a grant award by the American Thoracic Society/Alpha1 Foundation, grants HL14136 and HL085195 by the National Heart, Lung, and Blood Institute, grant 0660059Z by the American Heart Association, and an unrestricted grant from the Barry and Janet Lang Donor Advised Fund. This study was conducted with the support of the General Clinical Research Center of the University of Arizona.

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Dr Guerra is the recipient of a Parker B. Francis Fellowship.