Physiological Small Airways Dysfunction and the Bronchodilator Response in Adults With Asthma and Its Risk Factors: A Retrospective Analysis.

IF 3.7 3区医学 Q2 ALLERGY

Journal of Asthma and Allergy Pub Date : 2025-03-06 eCollection Date: 2025-01-01 DOI:10.2147/JAA.S489893

Mohammed A Almeshari, Nowaf Y Alobaidi, James A Stockley, Robert A Stockley, Prasad Nagakumar, Benjamin Paul Sutton, Elizabeth Sapey

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引用次数: 0

Abstract

Background: Physiological evidence of small airways dysfunction (SAD) is present in some patients with asthma and is associated with poor disease control. It is unclear if this represents a distinct phenotype of asthma or if it is an early manifestation of the disease. The study aimed to evaluate SAD in asthma and its clinical associations.

Methods: A retrospective analysis of routinely collected health data obtained from adults referred for routine spirometric assessment as part of their clinical management. The Maximal Mid-Expiratory Flow (MMEF) z-scores were used to assess the prevalence and association factors for SAD. Pre- and post-bronchodilator data of MMEF and FEV₁ in patients with and without SAD or airflow obstruction (AO) were analysed.

Results: A total of 1094 patients were included. 366 (33.5%) had evidence of SAD of whom 261 (71.3%) also had AO. Current smokers were at an increased risk of having SAD (OR: 2.05; 95% CI: 1.43-2.93). 214 patients had Bronchodilator response (BDR) data with 157 (73.4%) demonstrating BDR for MMEF and 121 (56.5%) for FEV₁. SAD at baseline was associated with a significant BDR for FEV₁ (OR of 3.59 (95% CI: 1.77-7.57)) and MMEF (OR of 2.89 (95% CI: 1.41-5.95)). Males were less likely to have a positive BDR for MMEF than females (OR of 0.46; 95% CI: 0.24-0.89).

Conclusion: SAD is common in asthma and is related to the presence of AO, cigarette smoking and is associated with increased BDR for both FEV₁ and MMEF. The assessment of SAD in routine clinical practice may help identify airway impairment early for the initiation of targeted therapies.

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成人哮喘患者的生理性小气道功能障碍和支气管扩张剂反应及其危险因素：回顾性分析。

背景：一些哮喘患者存在小气道功能障碍（SAD）的生理证据，并与疾病控制不良相关。目前尚不清楚这是否代表哮喘的一种独特表型，还是该疾病的早期表现。本研究旨在评估SAD在哮喘中的作用及其临床相关性。方法：回顾性分析常规收集的成人健康数据，这些成年人接受常规肺活量测定评估，作为其临床管理的一部分。最大呼气中流量（MMEF） z评分用于评估SAD的患病率和相关因素。分析有无SAD或气流阻塞（AO）患者使用支气管扩张剂前后的MMEF和FEV1数据。结果：共纳入1094例患者。366例（33.5%）有SAD证据，其中261例（71.3%）同时有AO。当前吸烟者患SAD的风险增加(OR: 2.05；95% ci: 1.43-2.93)。214例患者有支气管扩张剂反应（BDR）数据，其中157例（73.4%）为MMEF， 121例（56.5%）为FEV1。基线时的SAD与FEV1 （OR为3.59 (95% CI: 1.77-7.57)）和MMEF （OR为2.89 (95% CI: 1.41-5.95)）的显著BDR相关。男性MMEF BDR阳性的可能性低于女性(OR为0.46；95% ci: 0.24-0.89)。结论：SAD在哮喘中很常见，与AO、吸烟有关，并与FEV1和MMEF的BDR升高有关。在常规临床实践中对SAD的评估可能有助于及早发现气道损伤，以便开始靶向治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Asthma and Allergy Medicine-Immunology and Allergy

CiteScore

5.30

自引率

6.20%

发文量

185

审稿时长

16 weeks

期刊介绍： An international, peer-reviewed journal publishing original research, reports, editorials and commentaries on the following topics: Asthma; Pulmonary physiology; Asthma related clinical health; Clinical immunology and the immunological basis of disease; Pharmacological interventions and new therapies. Although the main focus of the journal will be to publish research and clinical results in humans, preclinical, animal and in vitro studies will be published where they shed light on disease processes and potential new therapies.