Li Yang, Su Kang-Cheng, Hsiao Yi-Han, Chou Kun-Ta, Li Yen-Jung, Jeng Tien-Hsin, Ko Hsin-Kuo, Perng Diahn-Warng
Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, 11217, Taiwan, Republic of China.
School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan, Republic of China.
Int J Chron Obstruct Pulmon Dis. 2025 Mar 27;20:821-830. doi: 10.2147/COPD.S505855. eCollection 2025.
Small airway dysfunction (SAD) is prevalent in asthma and chronic obstructive pulmonary disease (COPD). Aging is acknowledged to be associated with the loss of small airway structures. However, the impact of aging and pathophysiological changes on SAD in asthma and COPD remains unclear. We aimed to investigate the impact of aging and disease entity on pathophysiological change-related SAD in asthma and COPD assessed by spirometry and impulse oscillometry (IOS).
We retrospectively reviewed adult patients diagnosed with asthma or COPD between May 2017 and August 2021 in Taipei Veterans General Hospital. Treatment-naïve COPD patients aged ≥60 years were enrolled, along with age- and gender-matched elderly asthmatics (EA), and younger asthmatics aged <60 years (YA) for comparison. All participants underwent spirometry and IOS with a bronchodilator test. Blood eosinophil counts (BECs) and immunoglobulin E(IgE) levels were documented if blood tests were conducted at the time of diagnosis.
The mean age of YA, EA, and COPD were 44, 73, and 73 years, respectively. The FEV, FEV/FVC and FEF% were higher in the YA followed by EA and COPD groups. The spirometric values were significantly correlated with IOS parameters in both asthmatic and COPD groups. No significant differences were observed in baseline IOS parameters among the three groups for participants with FEV ≥80% predicted. However, in patients with FEV< 80% predicted, COPD patients exhibited significantly worse spirometric values and most IOS parameters (except R-R) compared to asthmatics. Additionally, asthmatics with AX reduction ≥35% exhibited significantly higher levels of blood eosinophil counts and IgE.
Aging process contributes to more impact on small airway reactance in asthma, while disease entity in COPD exhibits worse spirometric and IOS parameters compared to the age- and gender-matched EA.
小气道功能障碍（SAD）在哮喘和慢性阻塞性肺疾病（COPD）中普遍存在。衰老被认为与小气道结构的丧失有关。然而，衰老和病理生理变化对哮喘和COPD中SAD的影响仍不清楚。我们旨在研究衰老和疾病实体对通过肺活量测定和脉冲振荡法（IOS）评估的哮喘和COPD中与病理生理变化相关的SAD的影响。
我们回顾性分析了2017年5月至2021年8月在台北荣民总医院诊断为哮喘或COPD的成年患者。纳入年龄≥60岁的初治COPD患者，以及年龄和性别匹配的老年哮喘患者（EA）和年龄<60岁的年轻哮喘患者（YA）进行比较。所有参与者均接受肺活量测定和IOS检查，并进行支气管扩张试验。如果在诊断时进行了血液检查，则记录血嗜酸性粒细胞计数（BEC）和免疫球蛋白E（IgE）水平。
YA、EA和COPD组的平均年龄分别为44岁、73岁和73岁。YA组的第1秒用力呼气容积（FEV₁）、FEV₁/用力肺活量（FVC）和呼气流量峰值（FEF₂₅%₋₇₅%）高于EA组和COPD组。哮喘组和COPD组的肺活量测定值与IOS参数均显著相关。对于预测FEV₁≥80%的参与者，三组的基线IOS参数无显著差异。然而，在预测FEV₁<80%的患者中，与哮喘患者相比，COPD患者的肺活量测定值和大多数IOS参数（除了R-R）明显更差。此外，AX降低≥35%的哮喘患者血嗜酸性粒细胞计数和IgE水平显著更高。
衰老过程对哮喘中小气道反应性的影响更大，而与年龄和性别匹配的EA相比，COPD的疾病实体表现出更差的肺活量测定和IOS参数。
