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Clinical significance of small airway obstruction markers in patients with asthma

机译：哮喘患者小气道阻塞标志物的临床意义

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Summary: Background: The role of small airway obstruction in the clinical expression of asthma is incompletely understood. Objective: We tested the hypotheses that markers of small airway obstruction are associated with (i) increased asthma severity, (ii) impaired asthma control and quality of life and (iii) frequent exacerbations. Methods: Seventy-four adults with asthma and 18 healthy control subjects underwent impulse oscillometry (IOS), multiple breath inert gas washout (MBW), body plethysmography, single-breath determination of carbon monoxide uptake and spirometry. Patients completed the six-point Asthma Control Questionnaire (ACQ-6) and standardized Asthma Quality of Life Questionnaire [AQLQ(S)]. Asthma severity was classified according to the Global Initiative for Asthma (GINA) treatment steps. Results: The putative small airway obstruction markers Sacin, resistance at 5 Hz minus resistance at 20 Hz (R5-R20) and reactance area (AX) were not independently associated with asthma severity, control, quality of life or exacerbations. In contrast, markers of total (R5) and mean airway resistance of large and small airways (R20) were significantly higher in the severe asthma group compared with the mild-moderate group (0.47 vs. 0.37, P 0.05 for R5; 0.39 vs. 0.31, P 0.01 for R20). The strongest independent contributors to ACQ-6 score were R20 and forced expiratory volume in one second (% pred.), and the strongest independent contributors to AQLQ(S) score were R20 and forced vital capacity (% pred.). A history of one or more exacerbations within the previous year was independently associated with R20. Conclusions and Clinical Relevance: Previously reported markers of small airway obstruction do not appear to be independently associated with asthma disease expression. In contrast, the IOS parameter R20, a marker of mean airway resistance of both large and small airways, appears to have independent clinical significance. These observations require confirmation in prospective longitudinal studies.
机译：摘要：背景：小气道阻塞在哮喘临床表达中的作用尚不完全清楚。目的：我们检验了以下假设：小气道阻塞的标志物与（i）哮喘严重程度增加，（ii）哮喘控制和生活质量受损以及（iii）频繁发作有关。方法：对74名患有哮喘的成人和18名健康对照受试者进行了脉冲示波法（IOS），多次呼吸惰性气体冲洗（MBW），人体体积描记法，单次呼吸测定一氧化碳摄取量和肺活量测定法。患者完成了六点哮喘控制问卷（ACQ-6）和标准化的哮喘生活质量问卷[AQLQ（S）]。根据全球哮喘倡议（GINA）治疗步骤对哮喘的严重程度进行了分类。结果：假定的小气道阻塞标志物Sacin，5 Hz的抵抗力减去20 Hz的抵抗力（R5-R20）和电抗面积（AX）与哮喘的严重程度，控制，生活质量或恶化没有独立相关。相比之下，重度哮喘组的总（R5）和大，小气道平均气道阻力（R20）的指标明显高于轻度-中度组（0.45 vs. 0.37，P <0.05 R5; 0.39 vs 0.31，对于R20，P <0.01）。 ACQ-6评分最强的独立贡献者是R20和一秒钟内的强迫呼气量（％占比），而AQLQ（S）评分最强的独立贡献者是R20和强迫肺活量（％占比）。上一年有一次或多次加重病史与R20独立相关。结论与临床意义：先前报道的小气道阻塞标志物似乎与哮喘疾病的表达无关。相反，IOS参数R20是大，小气道的平均气道阻力的标志，似乎具有独立的临床意义。这些观察结果需要前瞻性纵向研究的证实。

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