Abstract

Asthma is the most common chronic lung disease. The fate of patients with long standing (LS) asthma is of interest. The large number of LS asthmatics at two inner-city hospitals was an impetus to this study, LS asthma: > 30 years. All patients were non-smokers or minimal smokers and had no other lung disease. Data obtained: gender, race, age, body mass index (BMI), forced expiratory volume in 1 second (FEV1), FEV1% predicted, forced vital capacity (FVC), FVC% predicted, FEV1/FVC, diffusion capacity for carbon monoxide percent (DLCO%) predicted, functional residual capacity (FRC), inhaled bronchodilator (BD) usage and response, and inhaled corticosteroid (ICS) usage. For the 65 patients, 37 (57%) were black, 48 (74%) were females, mean age was 53.0 ± 14.7, and 58 (89%) were overweight/obese. FEV1 and FVC% predicted were slightly/moderately reduced in 26 and 24 patients; severely reduced in 27 and 17%, respectively. FEV1/FVC was slightly reduced in 17%, moderately/severely reduced in 11% and was normal in 37%. DLCO% predicted was normal in 28%, slightly/moderately reduced in 31% and was severely reduced in 6%. FRC was increased in only 37%. A typical LS asthmatic is an overweight/obese woman who has a decreased DLCO, FEV1 and FVC, a normal or slightly decreased FEV1/FVC and FRC, and regularly uses BD/ICS without an acute BD response. Using FEV1/FVC ratio to diagnose or follow patients with asthma can be misleading.

Key words: Long standing asthma, obesity, bronchodilator response, restrictive impairment, diffusing capacity, pulmonary vasculopathy