Persistent Airflow Limitation Increases Exacerbation Risk in Patients With Mild Asthma

Persistent airflow limitation can occur in patients with mild asthma and is associated with eosinophilic inflammation and a higher risk of exacerbations, according to a post-hoc analysis of the ATLANTIS study.

Tessa Kole, MD, of the University Medical Center Groningen and the Groningen Research Institute for Asthma and COPD, and colleagues conducted the post-hoc analysis and published their findings in The Lancet Respiratory Medicine.

The study included adults up to 65 years old who were diagnosed with asthma at least 6 months before the study and who had available data on their post-bronchodilator forced expiratory volume in 1 second and forced vital capacity (n=760). The mean patient age was 44 years, and 58% of patients were women. Most patients were never smokers (76%), and 33% had persistent airflow limitation.

Persistent airflow limitation was detected in patients with severe asthma, but also was reported in 16% of patients receiving Global Initiative for Asthma (GINA) step 1 treatment and in 29% of patients receiving GINA step 2 treatment.

At a 1-year follow-up, persistent airflow limitation was independently associated with older age (46 years old in patients with persistent airflow limitation vs 43 years old in patients without persistent airflow limitation). It also was associated with a longer duration of asthma (24 years vs 12 years), being male (51% vs 38%), higher blood eosinophil counts, a higher frequency of small airway dysfunction, and more exacerbations.

“[Persistent airflow limitation] is not only present in severe disease, but also in a considerable proportion of patients with milder disease,” Dr. Kole and colleagues concluded. “In patients with mild asthma, [persistent airflow limitation] is associated with eosinophilic inflammation and a higher risk of exacerbations. Our findings are important because they suggest that increasing treatment intensity should be considered in patients with milder asthma and [persistent airflow limitation].”

Kole TM, Vanden Berghe E, Kraft M, et al. Predictors and associations of the persistent airflow limitation phenotype in asthma: a post-hoc analysis of the ATLANTIS study. Lancet Respir Med. 2022. doi:10.1016/S2213-2600(22)00185-0