Airways obstruction in patients with long-term asthma consistent with 'irreversible asthma'.
OBJECTIVE
To describe a series of eight patients with long-term asthma and pulmonary function consistent with "end-stage," irreversible obstruction.


METHODS
Retrospective descriptive analysis of patients with severe asthma.


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


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


METHODS
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 alpha1-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.
Backman
K S
KS
Department of Medicine, Northwestern Memorial Hospital and Northwestern University Medical School, Chicago, IL 60611, USA.
Greenberger
P A
PA
Patterson
R
R
D000328:Adult; D000402:Airway Obstruction / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D001249:Asthma / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006967:Hypersensitivity / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D008875:Middle Aged; D011237:Predictive Value of Tests; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012882:Skin Tests; D013997:Time Factors
D005938:Glucocorticoids; D011241:Prednisone