Are we overlooking persistent small airways dysfunction in community-managed asthma?

William J. Anderson, Emma Zajda, Brian J. Lipworth

Research output: Contribution to journalArticle

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Abstract

Background Whether small airways dysfunction persists in patients with asthma receiving standard community treatment is unknown. Impulse oscillometry (IOS) is a sensitive measure of small airways function. Objective To assess the degree of small airways dysfunction in a cross-section of patients with community-managed asthma. Methods We analyzed primary care referral data from patients with persistent asthma (n = 378) receiving standard community therapy, screened using spirometry and IOS. We compared patients by British Thoracic Society asthma treatment step (2–4). Results Step 2 patients were not different from step 3 patients receiving long-acting beta-agonist (LABA). Step 4 patients differed from step 2 by: higher inhaled corticosteroid (ICS) dose (P < .0001); lower forced expiratory volume in 1 second (FEV1%; P = .02) and forced mid-expiratory flow (FEF25–75%; P = .001); higher frequency of resonance (Fres; P = .02) and peripheral airway resistance (R5-R20; P = .006); whereas for steps 3 vs 4 there were differences in Fres (P < .05) and R5-R20 (P = .006). There were high proportions of abnormality for R5-R20 (>0.03 kPa/L/s) at steps 2, 3, and 4, respectively: 64.6%, 63.5%, and 69.9%. Step 2 patients receiving extra-fine particle ICS demonstrated lower total airway resistance at 5Hz (R5) vs patients receiving standard ICS (124.1% vs 138.3%, P < .05), with no difference in FEV1. At step 4, R5 remained elevated at 141.3% despite concomitant LABA, with only 2.4% using extra-fine ICS. Conclusion Persistent small airways dysfunction occurs despite treatment at steps 2 through 4 of current asthma guidelines. Extra-fine ICS may reduce airway resistance at step 2. Prospective studies with extra-fine ICS ± LABA at steps 2 through 4 are required to discern whether improving small airways function might result in long-term improved control.
Original languageEnglish
Pages (from-to)185-189
Number of pages5
JournalAnnals of Allergy, Asthma and Immunology
Volume109
Issue number3
DOIs
Publication statusPublished - Sep 2012
Externally publishedYes

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Asthma
Adrenal Cortex Hormones
Oscillometry
Airway Resistance
Spirometry
Therapeutics
Primary Health Care
Referral and Consultation
Prospective Studies
Guidelines

Cite this

Anderson, William J. ; Zajda, Emma ; Lipworth, Brian J. / Are we overlooking persistent small airways dysfunction in community-managed asthma?. In: Annals of Allergy, Asthma and Immunology. 2012 ; Vol. 109, No. 3. pp. 185-189.
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title = "Are we overlooking persistent small airways dysfunction in community-managed asthma?",
abstract = "Background Whether small airways dysfunction persists in patients with asthma receiving standard community treatment is unknown. Impulse oscillometry (IOS) is a sensitive measure of small airways function. Objective To assess the degree of small airways dysfunction in a cross-section of patients with community-managed asthma. Methods We analyzed primary care referral data from patients with persistent asthma (n = 378) receiving standard community therapy, screened using spirometry and IOS. We compared patients by British Thoracic Society asthma treatment step (2–4). Results Step 2 patients were not different from step 3 patients receiving long-acting beta-agonist (LABA). Step 4 patients differed from step 2 by: higher inhaled corticosteroid (ICS) dose (P < .0001); lower forced expiratory volume in 1 second (FEV1{\%}; P = .02) and forced mid-expiratory flow (FEF25–75{\%}; P = .001); higher frequency of resonance (Fres; P = .02) and peripheral airway resistance (R5-R20; P = .006); whereas for steps 3 vs 4 there were differences in Fres (P < .05) and R5-R20 (P = .006). There were high proportions of abnormality for R5-R20 (>0.03 kPa/L/s) at steps 2, 3, and 4, respectively: 64.6{\%}, 63.5{\%}, and 69.9{\%}. Step 2 patients receiving extra-fine particle ICS demonstrated lower total airway resistance at 5Hz (R5) vs patients receiving standard ICS (124.1{\%} vs 138.3{\%}, P < .05), with no difference in FEV1. At step 4, R5 remained elevated at 141.3{\%} despite concomitant LABA, with only 2.4{\%} using extra-fine ICS. Conclusion Persistent small airways dysfunction occurs despite treatment at steps 2 through 4 of current asthma guidelines. Extra-fine ICS may reduce airway resistance at step 2. Prospective studies with extra-fine ICS ± LABA at steps 2 through 4 are required to discern whether improving small airways function might result in long-term improved control.",
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Are we overlooking persistent small airways dysfunction in community-managed asthma? / Anderson, William J.; Zajda, Emma; Lipworth, Brian J.

In: Annals of Allergy, Asthma and Immunology, Vol. 109, No. 3, 09.2012, p. 185-189.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Are we overlooking persistent small airways dysfunction in community-managed asthma?

AU - Anderson, William J.

AU - Zajda, Emma

AU - Lipworth, Brian J.

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N2 - Background Whether small airways dysfunction persists in patients with asthma receiving standard community treatment is unknown. Impulse oscillometry (IOS) is a sensitive measure of small airways function. Objective To assess the degree of small airways dysfunction in a cross-section of patients with community-managed asthma. Methods We analyzed primary care referral data from patients with persistent asthma (n = 378) receiving standard community therapy, screened using spirometry and IOS. We compared patients by British Thoracic Society asthma treatment step (2–4). Results Step 2 patients were not different from step 3 patients receiving long-acting beta-agonist (LABA). Step 4 patients differed from step 2 by: higher inhaled corticosteroid (ICS) dose (P < .0001); lower forced expiratory volume in 1 second (FEV1%; P = .02) and forced mid-expiratory flow (FEF25–75%; P = .001); higher frequency of resonance (Fres; P = .02) and peripheral airway resistance (R5-R20; P = .006); whereas for steps 3 vs 4 there were differences in Fres (P < .05) and R5-R20 (P = .006). There were high proportions of abnormality for R5-R20 (>0.03 kPa/L/s) at steps 2, 3, and 4, respectively: 64.6%, 63.5%, and 69.9%. Step 2 patients receiving extra-fine particle ICS demonstrated lower total airway resistance at 5Hz (R5) vs patients receiving standard ICS (124.1% vs 138.3%, P < .05), with no difference in FEV1. At step 4, R5 remained elevated at 141.3% despite concomitant LABA, with only 2.4% using extra-fine ICS. Conclusion Persistent small airways dysfunction occurs despite treatment at steps 2 through 4 of current asthma guidelines. Extra-fine ICS may reduce airway resistance at step 2. Prospective studies with extra-fine ICS ± LABA at steps 2 through 4 are required to discern whether improving small airways function might result in long-term improved control.

AB - Background Whether small airways dysfunction persists in patients with asthma receiving standard community treatment is unknown. Impulse oscillometry (IOS) is a sensitive measure of small airways function. Objective To assess the degree of small airways dysfunction in a cross-section of patients with community-managed asthma. Methods We analyzed primary care referral data from patients with persistent asthma (n = 378) receiving standard community therapy, screened using spirometry and IOS. We compared patients by British Thoracic Society asthma treatment step (2–4). Results Step 2 patients were not different from step 3 patients receiving long-acting beta-agonist (LABA). Step 4 patients differed from step 2 by: higher inhaled corticosteroid (ICS) dose (P < .0001); lower forced expiratory volume in 1 second (FEV1%; P = .02) and forced mid-expiratory flow (FEF25–75%; P = .001); higher frequency of resonance (Fres; P = .02) and peripheral airway resistance (R5-R20; P = .006); whereas for steps 3 vs 4 there were differences in Fres (P < .05) and R5-R20 (P = .006). There were high proportions of abnormality for R5-R20 (>0.03 kPa/L/s) at steps 2, 3, and 4, respectively: 64.6%, 63.5%, and 69.9%. Step 2 patients receiving extra-fine particle ICS demonstrated lower total airway resistance at 5Hz (R5) vs patients receiving standard ICS (124.1% vs 138.3%, P < .05), with no difference in FEV1. At step 4, R5 remained elevated at 141.3% despite concomitant LABA, with only 2.4% using extra-fine ICS. Conclusion Persistent small airways dysfunction occurs despite treatment at steps 2 through 4 of current asthma guidelines. Extra-fine ICS may reduce airway resistance at step 2. Prospective studies with extra-fine ICS ± LABA at steps 2 through 4 are required to discern whether improving small airways function might result in long-term improved control.

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DO - 10.1016/j.anai.2012.06.022

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JO - Annals of Allergy, Asthma and Immunology

JF - Annals of Allergy, Asthma and Immunology

SN - 1081-1206

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