Unsuspected loss of lung elastic recoil in chronic persistent asthma
Unsuspected loss of lung elastic recoil in chronic persistent asthma
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DOI：
10.1378/chest.121.3.715
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发表时间：
2002-03-01
期刊：
影响因子：
9.6
通讯作者：
Zamel, N
中科院分区：
文献类型：
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作者：
Gelb, AF;Licuanan, J;Zamel, N
研究目的：目的：探讨慢性持续性哮喘患者固定最大呼气流量（V）over dot max）受限的进展及其机制。方法：选择21例哮喘患者，在经过最佳治疗后，临床症状稳定，并根据呼气流量受限的严重程度分为3组：（1）A组5例（4名女性;平均+/-SD年龄，51 +/-17岁）轻度持续性哮喘（2）B组包括11例哮喘患者，（3名女性;平均年龄64 ± 11岁），中度持续性哮喘（FEV1为预测值的60 - 80%），连续测量12 +/-4耳的FEV1;（3）C组包括5名哮喘患者（3名女性，平均年龄55~16岁），严重持续性哮喘（FEV1 <60%预测值），连续FEV1测量11 +/-5 years。B组患者肺弹性回缩率（TLC）均明显降低（16 +/-4 cm H2O）和C组（15 +/-5 cm H2O），但A组无或极轻微（22 +/-1 cm H2O）[p <0.01]，弹性回缩损失分别占80%和70%TLC时最大呼气气流（（V）超过点最大值）减少的34%和50%。与以前的纵向数据比较表明，个别哮喘时，在临床上，稳定的条件下仍然占主导地位，在相同的FEV1百分比预测分类组作为在目前的study.Conclusion：慢性中度和重度持续性哮喘患者，尽管最佳治疗，已减少（V）超过点最大多年的部分原因（早期？）未知机制导致的肺弹性回缩损失。这挑战了当前气道重塑的概念。
Study objectives: To investigate the progression and mechanism(s) for fixed maximum expiratory airflow ((V)over dot max) limitation in patients with chronic persistent asthma.Methods: When optimally treated and in clinically stable condition, we studied 21 asthmatic patients and classified them into three groups based on the severity, of expiratory airflow limitation: (1) group A included 5 asthmatic patients (four women; mean +/-SD age, 51 +/- 17 years) with mild persistent asthma (FEV1 > 80% predicted) with serial FEV1 measurements obtained prior to the present study for 16 +/- 4 years; (2) group B included 11 asthmatic patients (three women; mean age, 64 +/- 11 years) with moderate persistent asthma (FEV1 of 60 to 80% predicted) with serial FEV1 measurements for 12 +/- 4 ears; and (3) group C included 5 asthmatic patients (three women; mean age, 55 16 years) with severe persistent asthma (FEV1 < 60% predicted) with serial FEV1 measurements for 11 +/- 5 years.Results: Lung CT indicated no or trivial emphysema, and diffusion was normal in all asthmatics. There was a marked loss of lung elastic recoil at total lung capacity (TLC) in all asthmatic patients in group B (16 +/- 4 cm H2O) and group C (15 +/- 5 cm H2O), but none or minimal in group A (22 +/- 1 cm H2O) [p < 0.01], and loss of elastic recoil accounted for 34% and 50% of decreased maximal expiratory airflow ((V)over dot max) at 80% and 70% TLC, respectively. Comparison with previous longitudinal data indicated individual asthmatics when in clinically, stable condition remained predominantly, in the same FEV1 percent predicted classification group as in the current study.Conclusion: Patients with chronic moderate and severe persistent asthma, despite optimal therapy, have reduced (V)over dot max for many years in part due to (early?) loss of lung elastic recoil from unknown mechanism(s). This challenges current concept of airway, remodeling.