PT - JOURNAL ARTICLE AU - Regina Maria Carvalho-Pinto AU - Alberto Cukier AU - Luciene Angelini AU - Frederico Leon Arrabal Fernandes AU - João Marcos Salge AU - Rafael Stelmach TI - Heterogeneity of small airways flow and hyperinflation are markers of a persistent obstruction phenotype in severe non-controlled asthmatics DP - 2012 Sep 01 TA - European Respiratory Journal PG - P2255 VI - 40 IP - Suppl 56 4099 - http://erj.ersjournals.com/content/40/Suppl_56/P2255.short 4100 - http://erj.ersjournals.com/content/40/Suppl_56/P2255.full SO - Eur Respir J2012 Sep 01; 40 AB - 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.View this table: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.