Airways obstruction in patients with long-term asthma consistent with 'irreversible asthma'

Objective: To describe a series of eight patients with long-term asthma and pulmonary function consistent with 'end-stage,' irreversible obstruction. Design: Retrospective descriptive analysis of patients with severe asthma. Setting: A university-based allergy-immunology service with a large population of corticosteroid-dependent patients with asthma. Patients: Eight patients with long-standing asthma and apparently irreversible airways obstruction despite long-term oral and inhaled corticosteroid therapy. Measurements: Pulmonary function data, radiographic studies including chest radiograph and high-resolution CT of the chest, and serologic analysis to rule out allergic bronchopulmonary aspergillosis and α₁-antitrypsin deficiency had been performed as indicated, and these results were obtained through chart review. Results: The age of the patients ranged from 41 to 58 years, with a mean duration of asthma of 39 years (SD= 12.4 years). No patient had evidence of any other pulmonary disease process. The mean duration of daily or alternate-day oral corticosteroid treatment was 15.8 years (SD = 11.8 years). Despite intensive pharmacotherapy, all patients had an FEV₁ 57% (42±12%) with marked small airways disease as reflected in the forced expiratory flow between 25% and 75% of the FVC. Three of the eight patients demonstrated an accelerated decline in FEV₁ despite continuous systemic corticosteroids. Conclusions: We have described a series of eight patients with long-standing asthma who demonstrate irreversible airways obstruction despite long-term systemic and inhaled corticosteroids. The term 'end-stage asthma' or irreversible asthma might be applied to these patients in whom fixed obstruction has occurred in the absence of other pulmonary diseases.