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Airways Obstruction in Patients With Long-term Asthma Consistent With `Irreversible Asthma'

Kenneth S. Backman; Paul A. Greenberger; Roy Patterson
Author and Funding Information

From the Division of Allergy-Immunology and the Ernest S. Bazley Asthma and Allergic Diseases Center, Department of Medicine, Northwestern Memorial Hospital and Northwestern University Medical School, Chicago


1997 by the American College of Chest Physicians


Chest. 1997;112(5):1234-1240. doi:10.1378/chest.112.5.1234
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Abstract

Objective: To describe a series of eight patients with long-term asthma and pulmonary function consistent with "end-stage," irreversible obstruction.

Design: Retrospective descriptive analysis of patients with severe asthma.

Setting: A university-based allergy-immunology service with a large population of corticosteroid-dependent patients with asthma.

Patients: Eight patients with long-standing asthma and apparently irreversible airways obstruction despite long-term oral and inhaled corticosteroid therapy.

Measurements: Pulmonary function data, radiographic studies including chest radiograph and high-resolution CT of the chest, and serologic analysis to rule out allergic bronchopulmonary aspergillosis and α1-antitrypsin deficiency had been performed as indicated, and these results were obtained through chart review.

Results: The age of the patients ranged from 41 to 58 years, with a mean duration of asthma of 39 years (SD=12.4 years). No patient had evidence of any other pulmonary disease process. The mean duration of daily or alternate-day oral corticosteroid treatment was 15.8 years (SD=11.8 years). Despite intensive pharmacotherapy, all patients had an FEV1 57% (42±12%) with marked small airways disease as reflected in the forced expiratory flow between 25% and 75% of the FVC. Three of the eight patients demonstrated an accelerated decline in FEV1 despite continuous systemic corticosteroids.

Conclusions: We have described a series of eight patients with long-standing asthma who demonstrate irreversible airways obstruction despite long-term systemic and inhaled corticosteroids. The term "end-stage asthma" or irreversible asthma might be applied to these patients in whom fixed obstruction has occurred in the absence of other pulmonary diseases.


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