Irreversible airway obstruction in asthma

Asthma is generally characterized by fully reversible airway obstruction. However, a significant proportion of asthma patients demonstrate an incomplete reversibility of airway obstruction (IRAO) despite optimal treatment and the absence of a significant smoking history. Such partially irreversible airway obstruction may be due to residual airway inflammation, particularly of the eosinophilic type, and structural changes. Risks factors for IRAO include reduced pulmonary function early in life, frequent exacerbations, smoking, continuing exposure to a sensitizing agent, and adult-onset asthma. IRAO is associated with increased disease severity and increased asthma-related morbidity and mortality. Optimal asthma control, including prevention of asthma exacerbations, smoking avoidance, and sufficient anti-inflammatory therapy, should be implemented in an effort to avoid an accelerated decline in lung function and the development or worsening of IRAO.