Ventilation heterogeneity and oscillometry predict asthma control improvement following step-up inhaled therapy in uncontrolled asthma

© 2020 Asian Pacific Society of Respirology..

BACKGROUND AND OBJECTIVE: Abnormal peripheral airway function is an important feature of asthma and relates to asthma symptoms and poor asthma control. We aimed to determine whether peripheral airway function, as measured by forced oscillatory impedance and multiple-breath nitrogen washout (MBNW), relates to symptom improvement in asthmatic participants with uncontrolled asthma, after stepping up to high-dose ICS/LABA treatment.

METHODS: A total of 19 subjects (14 females, mean age: 29.9 ± 13.6 years) with uncontrolled asthma, as defined by an ACQ5 > 1.5, taking 500 μg/day fluticasone equivalent or less, underwent spirometry, plethysmography, fractional exhaled FeNO, forced oscillatory resistance (Rrs5Hz ) and reactance (Xrs5Hz ), and indices of MBNW ventilation heterogeneity (lung clearance index (LCI), diffusion-convection-dependent (Sacin) and convection-dependent (Scond)). Measurements were made before and after 8 weeks of treatment with fluticasone/formoterol combination inhaler 250/10 μg, 2 puffs twice daily.

RESULTS: Treatment improved ACQ5 (P = 0.0002), FEV1 (P = 0.02), FVC (P = 0.04), FeNO (P = 0.0008), Xrs5Hz (P = 0.01), LCI (P = 0.0002), Sacin (P = 0.006) and Scond (P = 0.01). At baseline, ACQ5 correlated with Xrs5Hz (rs = 0.52, P = 0.03) and Rrs5Hz (rs = 0.55, P = 0.02). The improvement in ACQ5 was predicted by more abnormal baseline LCI (P = 0.03), Scond (P = 0.02) and Rrs5Hz (P = 0.006). Baseline Scond was the best predictor of a clinically meaningful improvement in asthma control (ΔACQ > 0.5, ROC-AUC = 0.91, P = 0.007).

CONCLUSION: Step-up to high-dose combination treatment in uncontrolled asthma is associated with improved peripheral airway function as measured by Xrs5Hz and MBNW. Baseline MBNW and FOT parameters correlated with the improvement in symptoms and may predict a positive response to up-titration in uncontrolled asthmatic patients.

Errataetall:

CommentIn: Respirology. 2020 Aug;25(8):779-780. - PMID 32147896

Medienart:

E-Artikel

Erscheinungsjahr:

2020

Erschienen:

2020

Enthalten in:

Zur Gesamtaufnahme - volume:25

Enthalten in:

Respirology (Carlton, Vic.) - 25(2020), 8 vom: 16. Aug., Seite 827-835

Sprache:

Englisch

Beteiligte Personen:

Tang, Francesca S M [VerfasserIn]
Rutting, Sandra [VerfasserIn]
Farrow, Catherine E [VerfasserIn]
Tonga, Katrina O [VerfasserIn]
Watts, Joanna [VerfasserIn]
Dame-Carrol, Jessica R [VerfasserIn]
Bertolin, Amy [VerfasserIn]
King, Gregory G [VerfasserIn]
Thamrin, Cindy [VerfasserIn]
Chapman, David G [VerfasserIn]

Links:

Volltext

Themen:

Adrenal Cortex Hormones
Adrenergic beta-2 Receptor Agonists
Asthma control
CUT2W21N7U
Drug Combinations
Fluticasone
Fluticasone-formoterol
Forced oscillation technique
Formoterol Fumarate
Journal Article
Multiple-breath nitrogen washout
N762921K75
Nitrogen
Peripheral airway dysfunction
Research Support, Non-U.S. Gov't
Ventilation heterogeneity
W34SHF8J2K

Anmerkungen:

Date Completed 24.06.2021

Date Revised 24.06.2021

published: Print-Electronic

CommentIn: Respirology. 2020 Aug;25(8):779-780. - PMID 32147896

Citation Status MEDLINE

doi:

10.1111/resp.13772

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM306212994