title: Unsuspected loss of lung elastic recoil in chronic persistent asthma.
abstract: OBJECTIVE
  To investigate the progression and mechanism(s) for fixed maximum expiratory airflow (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 (FEV(1) > 80% predicted) with serial FEV(1) 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 (FEV(1) of 60 to 80% predicted) with serial FEV(1) measurements for 12 +/- 4 years; and (3) group C included 5 asthmatic patients (three women; mean age, 55 +/- 16 years) with severe persistent asthma (FEV(1) < 60% predicted) with serial FEV(1) measurements for 11 plus minus 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 H(2)O) and group C (15 +/- 5 cm H(2)O), but none or minimal in group A (22 +/- 1 cm H(2)O) [p < 0.01], and loss of elastic recoil accounted for 34% and 50% of decreased maximal expiratory airflow (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 FEV(1) percent predicted classification group as in the current study.
  
  
  CONCLUSIONS
  Patients with chronic moderate and severe persistent asthma, despite optimal therapy, have reduced 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.
authors.affiliation: Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, Lakewood, CA, USA. afgelb@msn.com
authors.forename: Arthur F
authors.initials: AF
authors.lastname: Gelb
authors.forename: Jesse
authors.initials: J
authors.lastname: Licuanan
authors.forename: Chris M
authors.initials: CM
authors.lastname: Shinar
authors.forename: Noe
authors.initials: N
authors.lastname: Zamel
mesh_terms: D000368:Aged; D001249:Asthma / Q000503:physiopathology*; D002908:Chronic Disease; D004548:Elasticity; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008448:Maximal Expiratory Flow Rate; D008875:Middle Aged; D011653:Pulmonary Diffusing Capacity; D012189:Retrospective Studies; D014109:Total Lung Capacity