Chest, Vol 105, 1024-1031, Copyright © 1994 by American College of Chest Physicians

ARTICLES

Persistence of airway obstruction and hyperresponsiveness in subjects with asthma remission

LP Boulet, H Turcotte and A Brochu
Unite de Recherche, Hopital Laval, Universite Laval, Sainte-Foy, Canada.

This study was designed to determine if there is residual airflow obstruction and/or airway hyperresponsiveness in adults with symptomatic asthma remission, and if age at remission or its duration influence these parameters. We studied 30 subjects, (20 men, 10 women, 28 atopics, aged 18 to 61 years; mean, 32 years) with a history of asthma (mean duration, 2 to 33 years) but who reported no symptoms or medication requirement for > or 2 years. They were individually matched for age, sex, and atopy, to a control group of 30 subjects without history of asthma. Each subject had a respiratory questionnaire and measurements of expiratory flows, lung volumes, and bronchodilator response. Morning/evening peak expiratory flow rates (PEFRs) were recorded for a 2-week period and two methacholine inhalation tests were obtained on separate days. Initial FEV1 and FVC for ex-asthmatics (controls) were, respectively, 91.0 +/- 2.5 percent and 97.8 +/- 2.3 percent (104.1 +/- 1.9 and 104.0 +/- 1.8 percent) of predicted values. Twenty nine ex-asthmatics (15 controls) had occasional respiratory symptoms, not attributed to asthma. Most subjects with asthma remission had evidences of mild airflow obstruction, associated to a methacholine response either increased in 11 (PC20 methacholine, 0.18 to 5.6 mg/ml) or "borderline" in 10 others (PC20 between 8 and 20 mg/ml). Airway responsiveness was normal (PC20 > 20 mg/ml) in 8 ex-asthmatics and in 21 controls (PC20 was under 8 mg/ml and between 10 and 20 mg/ml in, respectively, 5 and 4 controls). Mean reversibility of FEV1 after 200 micrograms of albuterol was 5.7 (range, -1.1 to 14.1 percent) compared with 2.5 (-4.4 to 10.5) in controls. Mean and maximal diurnal variation of PEFR were, respectively, 4.6 +/- 0.4 percent and 12.3 +/- 1.3 percent (controls, 2.9 +/- 0.3 and 7.0 +/- 0.8 percent). There was a significant correlation between PC20 and age at the diagnosis of asthma or at the onset of remission. Airway responsiveness was significantly less when asthma or remission of asthma occurred at a younger age, although there was no difference for baseline FEV1 and no significant correlation between PC20 and duration of asthma or of remission. Perception of bronchoconstriction was similar in both controls and ex- asthmatics. In conclusion, most ex-asthmatics who considered to be in asthma remission showed a persistent increase in airway responsiveness with or without mild airflow obstruction, suggesting that symptom report may be insufficient to determine that asthma is in true remission.

This article has been cited by other articles:

				P.-O. Ehrs, B.-M. Sundblad, and K. Larsson Quality of Life and Inflammatory Markers in Mild Asthma Chest, March 1, 2006; 129(3): 624 - 631. [Abstract] [Full Text] [PDF]

				Y. Yoo, J. Yu, D. K. Kim, and Y. Y. Koh Percentage Fall in FVC at the Provocative Concentration of Methacholine Causing a 20% Fall in FEV1 in Symptomatic Asthma and Clinical Remission During Adolescence. Chest, February 1, 2006; 129(2): 272 - 277. [Abstract] [Full Text] [PDF]

				P Lange, H Scharling, C S Ulrik, and J Vestbo Inhaled corticosteroids and decline of lung function in community residents with asthma Thorax, February 1, 2006; 61(2): 100 - 104. [Abstract] [Full Text] [PDF]

				J M Vonk, D S Postma, H M Boezen, M H Grol, J P Schouten, G H Koeter, and J Gerritsen Childhood factors associated with asthma remission after 30 year follow up Thorax, November 1, 2004; 59(11): 925 - 929. [Abstract] [Full Text] [PDF]

				H. Gono, K. Fujimoto, S. Kawakami, and K. Kubo Evaluation of airway wall thickness and air trapping by HRCT in asymptomatic asthma Eur. Respir. J., December 1, 2003; 22(6): 965 - 971. [Abstract] [Full Text] [PDF]

				E. R. McFadden Jr. Acute Severe Asthma Am. J. Respir. Crit. Care Med., October 1, 2003; 168(7): 740 - 759. [Abstract] [Full Text] [PDF]

				Y. Y. Koh, E. K. Kang, H. Kang, Y. Yoo, Y. Park, and C. K. Kim Bronchial Hyperresponsiveness in Adolescents With Long-term Asthma Remission: Importance of a Family History of Bronchial Hyperresponsiveness Chest, September 1, 2003; 124(3): 819 - 825. [Abstract] [Full Text] [PDF]

				G. P. Currie, D. K. C. Lee, K. Haggart, C. E. Bates, and B. J. Lipworth Effects of Montelukast on Surrogate Inflammatory Markers in Corticosteroid-treated Patients with Asthma Am. J. Respir. Crit. Care Med., May 1, 2003; 167(9): 1232 - 1238. [Abstract] [Full Text] [PDF]

				J M Vonk, H Jongepier, C I M Panhuysen, J P Schouten, E R Bleecker, and D S Postma Risk factors associated with the presence of irreversible airflow limitation and reduced transfer coefficient in patients with asthma after 26 years of follow up Thorax, April 1, 2003; 58(4): 322 - 327. [Abstract] [Full Text] [PDF]

				L.-P. Boulet Asymptomatic Airway Hyperresponsiveness: A Curiosity or an Opportunity to Prevent Asthma? Am. J. Respir. Crit. Care Med., February 1, 2003; 167(3): 371 - 378. [Full Text] [PDF]

				A. L. James, P. S. Maxwell, G. Pearce-Pinto, J. G. Elliot, and N. G. Carroll The Relationship of Reticular Basement Membrane Thickness to Airway Wall Remodeling in Asthma Am. J. Respir. Crit. Care Med., December 15, 2002; 166(12): 1590 - 1595. [Abstract] [Full Text] [PDF]

				N. Mojtabavi, G. Dekan, G. Stingl, and M. M. Epstein Long-Lived Th2 Memory in Experimental Allergic Asthma J. Immunol., November 1, 2002; 169(9): 4788 - 4796. [Abstract] [Full Text] [PDF]

				Y. Y. Koh, Y. Park, and C. K. Kim Maximal Airway Response in Adolescents With Long-term Asthma Remission and Persisting Airway Hypersensitivity: Its Profile and the Effect of Inhaled Corticosteroids Chest, October 1, 2002; 122(4): 1214 - 1221. [Abstract] [Full Text] [PDF]

				J. de Kluijver, C. E. Evertse, J. A. Schrumpf, H. van der Veen, A. H. Zwinderman, P. S. Hiemstra, K. F. Rabe, and P. J. Sterk Asymptomatic Worsening of Airway Inflammation during Low-Dose Allergen Exposure in Asthma: Protection by Inhaled Steroids Am. J. Respir. Crit. Care Med., August 1, 2002; 166(3): 294 - 300. [Abstract] [Full Text] [PDF]

				L.M. van den Toorn, S.E. Overbeek, J-B. Prins, H.C. Hoogsteden, and J.C. De Jongste Dyspnoea perception during clinical remission of atopic asthma Eur. Respir. J., June 1, 2002; 19(6): 1047 - 1050. [Abstract] [Full Text] [PDF]

				Y. Y. Koh, Y. H. Sun, H. S. Lim, C. K. Kim, and S. J. Hong Effect of Inhaled Budesonide on Bronchial Hyperresponsiveness in Adolescents With Clinical Remission of Asthma Chest, October 1, 2001; 120(4): 1140 - 1146. [Abstract] [Full Text] [PDF]

				J. BOUSQUET, P. K. JEFFERY, W. W. BUSSE, M. JOHNSON, and A. M. VIGNOLA Asthma . From Bronchoconstriction to Airways Inflammation and Remodeling Am. J. Respir. Crit. Care Med., May 1, 2000; 161(5): 1720 - 1745. [Full Text]

				E. Rönmark, E. Jönsson, and B. Lundbäck Remission of asthma in the middle aged and elderly: report from the Obstructive Lung Disease in Northern Sweden study Thorax, July 1, 1999; 54(7): 611 - 613. [Abstract] [Full Text]

				J. K. SONT, L. N. A. WILLEMS, E. H. BEL, J.H. J. M. van KRIEKEN, J. P. VANDENBROUCKE, P. J. STERK, and the AMPUL Study Group Clinical Control and Histopathologic Outcome of Asthma when Using Airway Hyperresponsiveness as an Additional Guide to Long-Term Treatment Am. J. Respir. Crit. Care Med., April 1, 1999; 159(4): 1043 - 1051. [Abstract] [Full Text] [PDF]

				P. Lange, J. Parner, J. Vestbo, P. Schnohr, and G. Jensen A 15-Year Follow-Up Study of Ventilatory Function in Adults with Asthma N. Engl. J. Med., October 22, 1998; 339(17): 1194 - 1200. [Abstract] [Full Text] [PDF]

				Corrigenda for vol. 155, p. 1267 Am. J. Respir. Crit. Care Med., July 1, 1997; 156(2): 674 - 678. [Full Text]