Skip to main content
PMC home page
Thorax logoLink to Thorax
. 2003 Apr;58(4):322–327. doi: 10.1136/thorax.58.4.322

Risk factors associated with the presence of irreversible airflow limitation and reduced transfer coefficient in patients with asthma after 26 years of follow up

J Vonk 1, H Jongepier 1, C Panhuysen 1, J Schouten 1, E Bleecker 1, D Postma 1
PMCID: PMC1746641  PMID: 12668795

Abstract

Background: Childhood asthma is generally believed to be a disorder with a good prognosis. However, some asthmatics develop irreversible airway obstruction, probably as a result of airway remodelling.

Methods: After 21–33 years, 228 adults (aged 13–44 years at baseline) with a history of asthma were re-examined to assess risk factors for the development of irreversible airway obstruction (IAO, forced expiratory volume in 1 second (FEV1) <80% predicted and reversibility <9% predicted) and a reduced postbronchodilator transfer coefficient (carbon monoxide transfer factor/alveolar volume, <80% predicted), both characteristics of COPD.

Results: At follow up, 41% did not have airway obstruction (NAO), 43% had reversible airway obstruction (RAO), and 16% had IAO; 23% had a reduced transfer coefficient. Patients with RAO had asthma-like characteristics (wheezing, asthma attacks, bronchial hyperresponsiveness (BHR)) while patients with IAO had COPD-like symptoms (cough, phlegm, dyspnoea) at follow up. The development of IAO is determined by a lower FEV1, less reversibility of airway obstruction and, surprisingly, less severe BHR at initial screening. Eighty percent of the patients with asthma who used anti-inflammatory medication still had airway obstruction, but IAO developed less frequently. Smoking was associated with a reduced transfer coefficient but not with the development of IAO. Female sex was associated with a reduced transfer coefficient, whereas corticosteroid use was not.

Conclusions: Although IAO and a low transfer coefficient are both characteristics of COPD, they represent distinct entities in adult asthmatics in terms of symptomatology, aetiology, and probably in therapeutic approaches and disease prevention.

Full Text

The Full Text of this article is available as a PDF (153.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BOOY-NOORD H., ORIE N. G., TEN CATE H. The influence of various drugs on the vital capacity of asthmatics. Int Arch Allergy Appl Immunol. 1957;10(6):321–341. doi: 10.1159/000228391. [DOI] [PubMed] [Google Scholar]
  2. Backman K. S., Greenberger P. A., Patterson R. Airways obstruction in patients with long-term asthma consistent with 'irreversible asthma'. Chest. 1997 Nov 5;112(5):1234–1240. doi: 10.1378/chest.112.5.1234. [DOI] [PubMed] [Google Scholar]
  3. Boulet L. P., Turcotte H., Brochu A. Persistence of airway obstruction and hyperresponsiveness in subjects with asthma remission. Chest. 1994 Apr;105(4):1024–1031. doi: 10.1378/chest.105.4.1024. [DOI] [PubMed] [Google Scholar]
  4. Brown P. J., Greville H. W., Finucane K. E. Asthma and irreversible airflow obstruction. Thorax. 1984 Feb;39(2):131–136. doi: 10.1136/thx.39.2.131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Elias J. A. Airway remodeling in asthma. Unanswered questions. Am J Respir Crit Care Med. 2000 Mar;161(3 Pt 2):S168–S171. doi: 10.1164/ajrccm.161.supplement_2.a1q4-4. [DOI] [PubMed] [Google Scholar]
  6. Finucane K. E., Greville H. W., Brown P. J. Irreversible airflow obstruction. Evolution in asthma. Med J Aust. 1985 May 27;142(11):602–604. [PubMed] [Google Scholar]
  7. Gerritsen J., Koëter G. H., Postma D. S., Schouten J. P., Knol K. Prognosis of asthma from childhood to adulthood. Am Rev Respir Dis. 1989 Nov;140(5):1325–1330. doi: 10.1164/ajrccm/140.5.1325. [DOI] [PubMed] [Google Scholar]
  8. Grol M. H., Gerritsen J., Vonk J. M., Schouten J. P., Koëter G. H., Rijcken B., Postma D. S. Risk factors for growth and decline of lung function in asthmatic individuals up to age 42 years. A 30-year follow-up study. Am J Respir Crit Care Med. 1999 Dec;160(6):1830–1837. doi: 10.1164/ajrccm.160.6.9812100. [DOI] [PubMed] [Google Scholar]
  9. Hudon C., Turcotte H., Laviolette M., Carrier G., Boulet L. P. Characteristics of bronchial asthma with incomplete reversibility of airflow obstruction. Ann Allergy Asthma Immunol. 1997 Feb;78(2):195–202. doi: 10.1016/s1081-1206(10)63387-x. [DOI] [PubMed] [Google Scholar]
  10. Lange P., Parner J., Vestbo J., Schnohr P., Jensen G. A 15-year follow-up study of ventilatory function in adults with asthma. N Engl J Med. 1998 Oct 22;339(17):1194–1200. doi: 10.1056/NEJM199810223391703. [DOI] [PubMed] [Google Scholar]
  11. Lynch D. A., Newell J. D., Tschomper B. A., Cink T. M., Newman L. S., Bethel R. Uncomplicated asthma in adults: comparison of CT appearance of the lungs in asthmatic and healthy subjects. Radiology. 1993 Sep;188(3):829–833. doi: 10.1148/radiology.188.3.8351357. [DOI] [PubMed] [Google Scholar]
  12. Panhuysen C. I., Vonk J. M., Koëter G. H., Schouten J. P., van Altena R., Bleecker E. R., Postma D. S. Adult patients may outgrow their asthma: a 25-year follow-up study. Am J Respir Crit Care Med. 1997 Apr;155(4):1267–1272. doi: 10.1164/ajrccm.155.4.9105065. [DOI] [PubMed] [Google Scholar]
  13. Peat J. K., Woolcock A. J., Cullen K. Rate of decline of lung function in subjects with asthma. Eur J Respir Dis. 1987 Mar;70(3):171–179. [PubMed] [Google Scholar]
  14. Roorda R. J. Childhood asthma: outcome after 20 years. Pediatr Pulmonol Suppl. 1999;18:99–102. [PubMed] [Google Scholar]
  15. Roorda R. J., Gerritsen J., Van Aalderen W. M., Schouten J. P., Veltman J. C., Weiss S. T., Knol K. Risk factors for the persistence of respiratory symptoms in childhood asthma. Am Rev Respir Dis. 1993 Dec;148(6 Pt 1):1490–1495. doi: 10.1164/ajrccm/148.6_Pt_1.1490. [DOI] [PubMed] [Google Scholar]
  16. Roorda R. J., Gerritsen J., van Aalderen W. M., Schouten J. P., Veltman J. C., Weiss S. T., Knol K. Follow-up of asthma from childhood to adulthood: influence of potential childhood risk factors on the outcome of pulmonary function and bronchial responsiveness in adulthood. J Allergy Clin Immunol. 1994 Mar;93(3):575–584. doi: 10.1016/s0091-6749(94)70069-9. [DOI] [PubMed] [Google Scholar]
  17. Sakai F., Gamsu G., Im J. G., Ray C. S. Pulmonary function abnormalities in patients with CT-determined emphysema. J Comput Assist Tomogr. 1987 Nov-Dec;11(6):963–968. doi: 10.1097/00004728-198711000-00007. [DOI] [PubMed] [Google Scholar]
  18. Selroos O., Pietinalho A., Löfroos A. B., Riska H. Effect of early vs late intervention with inhaled corticosteroids in asthma. Chest. 1995 Nov;108(5):1228–1234. doi: 10.1378/chest.108.5.1228. [DOI] [PubMed] [Google Scholar]
  19. Ulrik C. S., Backer V. Nonreversible airflow obstruction in life-long nonsmokers with moderate to severe asthma. Eur Respir J. 1999 Oct;14(4):892–896. doi: 10.1034/j.1399-3003.1999.14d27.x. [DOI] [PubMed] [Google Scholar]
  20. Ulrik C. S., Lange P. Decline of lung function in adults with bronchial asthma. Am J Respir Crit Care Med. 1994 Sep;150(3):629–634. doi: 10.1164/ajrccm.150.3.8087330. [DOI] [PubMed] [Google Scholar]
  21. Vignola A. M., Kips J., Bousquet J. Tissue remodeling as a feature of persistent asthma. J Allergy Clin Immunol. 2000 Jun;105(6 Pt 1):1041–1053. doi: 10.1067/mai.2000.107195. [DOI] [PubMed] [Google Scholar]
  22. Xu X., Weiss S. T., Rijcken B., Schouten J. P. Smoking, changes in smoking habits, and rate of decline in FEV1: new insight into gender differences. Eur Respir J. 1994 Jun;7(6):1056–1061. [PubMed] [Google Scholar]
  23. de Gooijer A., Brand P. L., Gerritsen J., Koëter G. H., Postma D. S., Knol K. Changes in respiratory symptoms and airway hyperresponsiveness after 27 years in a population-based sample of school children. Eur Respir J. 1993 Jun;6(6):848–854. [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES