Lung function in adults with stable but severe asthma: air trapping and incomplete reversal of obstruction with bronchodilation
Lung function in adults with stable but severe asthma: air trapping and incomplete reversal of obstruction with bronchodilation
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DOI：
10.1152/japplphysiol.00329.2007
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发表时间：
2008-02-01
影响因子：
3.3
通讯作者：
Wenzel, Sally E.
中科院分区：
文献类型：
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作者：
Sorkness, Ronald L.;Bleecker, Eugene R.;Wenzel, Sally E.
百分之五到百分之十的哮喘病例长期控制不佳且难以治疗，这些严重病例导致与哮喘相关的发病率、死亡率和医疗保健利用率不成比例。虽然患有严重哮喘的人往往有更多的气道阻塞，但尚不清楚他们是否代表单峰哮喘人群的严重尾部，或严重哮喘表型。我们假设严重哮喘具有气道阻塞的特征性生理学特征，并且我们评估了来自国家心肺血液研究所严重哮喘研究计划的 287 名严重哮喘受试者和 382 名非严重哮喘受试者在稳定时间间隔内的肺量测定、肺容量和可逆性。我们将气道阻塞分为空气滞留 [以用力肺活量 (FVC) 表示] 和气流受限 [以 1 秒用力呼气量 (FEV1)/FVC 表示]。严重哮喘有明显的空气滞留，表现为 FEV1/FVC 整个范围内的 FVC 降低。该模式通过亚组中残余肺容量/总肺容量（TLC）的测量得到证实。相比之下，非重度哮喘即使在 FEV1/FVC 下也没有表现出明显的空气滞留
Five to ten percent of asthma cases are poorly controlled chronically and refractory to treatment, and these severe cases account for disproportionate asthma-associated morbidity, mortality, and health care utilization. While persons with severe asthma tend to have more airway obstruction, it is not known whether they represent the severe tail of a unimodal asthma population, or a severe asthma phenotype. We hypothesized that severe asthma has a characteristic physiology of airway obstruction, and we evaluated spirometry, lung volumes, and reversibility during a stable interval in 287 severe and 382 nonsevere asthma subjects from the National Heart, Lung, and Blood Institute Severe Asthma Research Program. We partitioned airway obstruction into components of air trapping [indicated by forced vital capacity (FVC)] and airflow limitation [indicated by forced expiratory volume in 1 s (FEV1)/FVC]. Severe asthma had prominent air trapping, evident as reduced FVC over the entire range of FEV1/FVC. This pattern was confirmed with measures of residual lung volume/total lung capacity (TLC) in a subgroup. In contrast, nonsevere asthma did not exhibit prominent air trapping, even at FEV1/FVC