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Heterogeneity of small airways flow and hyperinflation are markers of a persistent obstruction phenotype in severe non-controlled asthmatics

Regina Maria Carvalho-Pinto, Alberto Cukier, Luciene Angelini, Frederico Leon Arrabal Fernandes, João Marcos Salge, Rafael Stelmach
European Respiratory Journal 2012 40: P2255; DOI:
Regina Maria Carvalho-Pinto
1Pulmonary Division, Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, SP, Brazil
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Alberto Cukier
1Pulmonary Division, Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, SP, Brazil
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Luciene Angelini
1Pulmonary Division, Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, SP, Brazil
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Frederico Leon Arrabal Fernandes
1Pulmonary Division, Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, SP, Brazil
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João Marcos Salge
1Pulmonary Division, Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, SP, Brazil
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Rafael Stelmach
1Pulmonary Division, Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, SP, Brazil
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Abstract

Persistent functional impairment in some severe asthmatics,even after maximal treatment, is usually linked to inflammation, which does not explain all asthma limitations and seems to be determined by small airways structural changes too.

Objective: Evaluate functional mechanisms related to persistent airflow obstruction (PAO) after an intensive therapeutic regimen in severe asthmatics.

Methods: Non-controlled severe asthmatics received high inhaled corticosteroid dose (ICs) plus LABA for 12 weeks and oral corticosteroid (OC) in the first two weeks, after which they were classified into PAO by an FEV1 after BD< 80% plus FEV1/FVC ≤ 0.70. Complete airway reversibility were labeled non persistent airflow obstruction (NPAO). Both groups were compared. Ex smokers >10 pack-years were excluded.

Results: At baseline, FEF2575, RV/TLC and resistance (Raw) were significant different between NPAO and PAO.

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All PAO values, including Slope of phase III of the single breath nitrogen washout test (dN2), became different after OC and did not return to normal. ACQ in NPAO decreased to near normal values (1.75±0.94).

Conclusion: Persistent obstruction phenotype in severe asthmatics showed a high heterogeneity of airflow measured by dN2 and early airway closure due to high RV/TLC suggesting a fixed impairment in small airways. VEF1 changes in these patients seem to be influenced by small airway disease. PAO also impairs improvement in asthma control scores.

  • Asthma - management
  • Spirometry
  • Inflammation
  • © 2012 ERS
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Heterogeneity of small airways flow and hyperinflation are markers of a persistent obstruction phenotype in severe non-controlled asthmatics
Regina Maria Carvalho-Pinto, Alberto Cukier, Luciene Angelini, Frederico Leon Arrabal Fernandes, João Marcos Salge, Rafael Stelmach
European Respiratory Journal Sep 2012, 40 (Suppl 56) P2255;

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Heterogeneity of small airways flow and hyperinflation are markers of a persistent obstruction phenotype in severe non-controlled asthmatics
Regina Maria Carvalho-Pinto, Alberto Cukier, Luciene Angelini, Frederico Leon Arrabal Fernandes, João Marcos Salge, Rafael Stelmach
European Respiratory Journal Sep 2012, 40 (Suppl 56) P2255;
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