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Small airways disease in asthma with-and without- fixed airflow obstruction and COPD
PDPI Lampung & Bengkulu, 31 Mar 2021 17:38:11


Background and aim: Small airways disease (SAD) reported in COPD and asthma with fixed airflow obstruction (FAO) is due to airway remodeling, by which mechanism is uncommon in non-FAO asthma. We aimed to test whether SAD in non-FAO asthma is physiologically different from FAO-asthma and COPD.

Methods: We retrospectively reviewed cases of obstructive airway diseases (OAD) who underwent spirometry, body plethysmography, and impulse oscillometry [(total airway resistance at 5 Hz (R5), central resistance at 20 Hz (R20), and peripheral resistance; R5-R20 and reactance area (AX)]. OAD were; 1) COPD, 2) FAO-asthma, and 3) newly-diagnosed non-FAO asthma. FAO was defined as post-bronchodilator (BD) FEV1/FVC<0.7 and FEV1 <80%. SAD was determined by 1) RV/TLC ≥40%, or 2) post-BD R5-R20 >0.07 kPa.l−1s.

Results: A total of 73 patients [22 COPD, 26 FAO-asthma, and non-FAO asthma], 60% female, were analysed. Mean age for each group was 74±7, 69±7, and 59±7 years, p<0.001. RV/TLC ratio (adjusted by age) was higher in FAO-asthma and COPD (44±6% and 42±8%) than in non-FAO asthma (32±9%), p<0.001. Post-BD R5-R20 (median; range) was higher in FAO-asthma (0.14; 0.07-0.47) than in non-FAO asthma and COPD (0.11; 0.03-0.27 and 0.10; 0.01-0.39), p=0.05. Post-BD AX was significantly greater in FAO-asthma (13.2; 6.5-82.1) than in non-FAO asthma and COPD (8.6; 2.4-22.0, 10.0; 0.9-53.3), p=0.017. Prevalence of SAD by RV/TLC criterion in FAO-asthma, COPD, and non-FAO asthma was 69%, 59%, and 20%, p=0.001, while those by post-BD R5-R20 criterion was 96%, 68%, and 33%, respectively, p=0.01.

Conclusion: SAD in non-FAO asthma was less prevalent than in FAO-asthma and COPD by either RV/TLC ratio ≥40% or post-BD R5-R20 >0.07 kPa.l−1s.

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