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Evaluation of airway hyperresponsiveness and exhaled nitric oxide as risk factors for airway remodeling in patients with stable asthma

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Chronic eosinophilic airway inflammation, airflow limitation, and airway hyperresponsiveness (AHR) are distinctive features of bronchial asthma. Exhaled nitric oxide (eNO) is a marker of eosinophilic airway inflammation. Airway remodeling due to chronic airway inflammation results in fixed airway obstruction. Asthmatic patients have been reported to have greater declines in forced expiratory volume in 1 second (FEV1) over time than nonasthmatic patients. This longitudinal observational study aimed to elucidate outcomes and risk factors for the decline in FEV1 in patients with stable asthma. Postbronchodilator FEV1 was measured in 30 outpatients with stable asthma every 6 months for 5 years. We calculated the rate of decline in postbronchodilator FEV1 (deltaFEV1/year) in each subject and adjusted deltaFEV1/year with predictive FEV1. Patients were examined while their asthma was well controlled. In the first observation period, we measured AHR to methacholine (the provocative concentration of methacholine causing a 20% fall in FEV1 [PC20]). In the second observation period (defined as the period over 2 years from start of observation), we measured methacholine PC20 and eNO. The mean deltaFEV1/year (SEM) was −36 ± 4 mL/year and the adjusted deltaFEV1/year (SEM) was −0.015 ± 0.001/year. Adjusted deltaFEV1/year did not correlate with eNO measured during the second observation period or methacholine PC20 measured during the first observation period. On the other hand, methacholine PC20 measured during the latter period was correlated significantly with adjusted deltaFEV1/year. Persistent AHR may be a risk factor for longitudinal decline in FEV1 in asthma patients even if their asthma is stable and well controlled by inhaled corticosteroid.
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  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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