Airways obstruction in patients with long-term asthma consistent with 'irreversible asthma'

Area of Science:

• Pulmonology
• Allergy and Immunology
• Respiratory Medicine

Background:

• Severe asthma often involves chronic inflammation and progressive airflow limitation.
• Long-term management of severe asthma frequently includes oral and inhaled corticosteroids.
• Identifying distinct phenotypes of severe asthma is crucial for targeted treatment.

Purpose of the Study:

• To characterize a cohort of patients with long-standing asthma exhibiting pulmonary function consistent with irreversible obstruction.
• To investigate the clinical course and treatment response in patients with severe, corticosteroid-dependent asthma.

Main Methods:

• Retrospective analysis of eight patients with severe, long-standing asthma.
• Review of pulmonary function tests, chest imaging (radiography and high-resolution CT), and serologic markers.
• Assessment of patients receiving long-term oral and inhaled corticosteroid therapy.

Main Results:

• Patients had a mean asthma duration of 39 years and were treated with oral corticosteroids for a mean of 15.8 years.
• All patients presented with fixed airflow obstruction (FEV1 57% of predicted) and small airways disease.
• Three patients showed an accelerated decline in FEV1 despite continuous systemic corticosteroid use.

Conclusions:

• A subset of patients with long-standing asthma may develop irreversible airways obstruction despite optimal medical management.
• The term "end-stage asthma" may be applicable to these cases of fixed obstruction.
• Further research is needed to understand the mechanisms and optimal management of this severe asthma phenotype.