Genome Research Center for Allergy and Respiratory Disease, Soonchunhyang University Bucheon Hospital, 1174, Jung-Dong, Wonmi-Gu, Bucheon, Gyeonggi-Do 420-020, South Korea.
Respir Med. 2012 Jun;106(6):786-93. doi: 10.1016/j.rmed.2012.02.012. Epub 2012 Mar 23.
Chronic persistent airway obstruction has been observed in moderate-to-severe asthmatics despite treatment with inhaled corticosteroids. We investigated which airway changes were associated with this obstruction. High-resolution computed tomography (HRCT) was performed at study entry and reexamined at the time of follow-up when the FEV1 reached a maximally constant level after treatment for 1 year or more with inhaled corticosteroids. Bronchial wall area and air trapping extent were compared in the recovered group (n = 18) and the persistent airway obstruction group (n = 14). Bronchial wall area and air trapping of the initial HRCT were similar between the two groups. On follow-up HRCT, air trapping was markedly decreased in the recovered group compared with that on initial HRCT (P = 0.017), whereas bronchial wall area did not change. In the persistent-airway-obstruction group, these two parameters did not change during follow-up. When follow-up HRCT was compared, air trapping was significantly greater in the persistent-airway-obstruction group than in the recovered group (P = 0.003). Difference post-bronchodilator FEV1 value between at initial and 2nd HRCT exam was correlated with difference air trapping value between at initial and 2nd HRCT exam(%) on the follow-up HRCT (P = 0.017). The presence of persistent airflow obstruction were significantly associated with the air trapping % difference between initial and 2nd time (RR = 1.70, P = 0.018). Persistence of AT could be a main contributing factor to chronic persistent airflow obstruction in asthma.
尽管接受吸入皮质激素治疗，中重度哮喘患者仍存在慢性持续性气道阻塞。我们研究了哪些气道变化与这种阻塞有关。在接受吸入皮质激素治疗 1 年或更长时间后，FEV1 达到最大恒定水平时，进行高分辨率计算机断层扫描（HRCT）检查，并在随访时重新检查。在恢复组（n = 18）和持续性气道阻塞组（n = 14）中比较了支气管壁面积和空气滞留程度。两组初始 HRCT 的支气管壁面积和空气滞留程度相似。在随访 HRCT 上，与初始 HRCT 相比，恢复组的空气滞留明显减少（P = 0.017），而支气管壁面积没有变化。在持续性气道阻塞组中，这两个参数在随访期间没有变化。当比较随访 HRCT 时，持续性气道阻塞组的空气滞留明显大于恢复组（P = 0.003）。初始和第 2 次 HRCT 检查之间的支气管扩张后 FEV1 值差异与随访 HRCT 上初始和第 2 次 HRCT 检查之间的空气滞留值差异（%）相关（P = 0.017）。持续性气流阻塞的存在与初始和第 2 次时间之间的空气滞留%差异显著相关（RR = 1.70，P = 0.018）。空气滞留的持续存在可能是哮喘慢性持续性气流阻塞的一个主要促成因素。
