Asthma is not a common cause of severe chronic respiratory failure in non-smokers: ALOT study

https://doi.org/10.4081/monaldi.2005.643

Authors

  • G. Caramori | crm@unife.it Centro di Ricerca su Asma e BPCO, Università di Ferrara, Italy.
  • M. Fabbri Servizio di Fisiopatologia Respiratoria, Policlinico S. Orsola, Università di Bologna, Italy.
  • D. Paioli Servizio di Fisiopatologia Respiratoria, Policlinico S. Orsola, Università di Bologna, Italy.
  • F. Falcone Unità Operativa di Pneumotisiatria, Ospedale Bellaria, AUSL Città di Bologna, Italy.
  • C. Severino Unità Operativa di Pneumotisiatria, Ospedale Bellaria, AUSL Città di Bologna, Italy.
  • G. Felisatti Servizio di Pneumologia, Ospedale Comunità di Copparo, AUSL di Ferrara, Italy.
  • O. Arar Centro di Ricerca su Asma e BPCO, Università di Ferrara, Italy.
  • I.M. Adcock Airway Disease Section, National Heart and Lung Institute, Imperial College London, United Kingdom.
  • K. Fan Chung Airway Disease Section, National Heart and Lung Institute, Imperial College London, United Kingdom.
  • P.J. Barnes Airway Disease Section, National Heart and Lung Institute, Imperial College London, United Kingdom.
  • A. Ciaccia Centro di Ricerca su Asma e BPCO, Università di Ferrara, Italy.
  • A. Papi Centro di Ricerca su Asma e BPCO, Università di Ferrara, Italy.

Abstract

Background. Little is known about the long-term natural history of asthma and the long-term clinical and functional consequences in non-smoking patients. From a functional point of view, non-smoking asthmatic patients may have a significantly greater decline in forced expiratory volume in one second (FEV1) compared with nonasthmatic subjects and may develop chronic irreversible (fixed) airflow limitation. This has been related to the physiological consequences of chronic airway inflammation causing airway remodeling. However these lesions are all potentially reversible and there is little radiological evidence indicating lung destruction (pulmonary emphysema), which is potentially irreversible, in non-smoking asthmatics. Severe chronic respiratory failure is the major cause of mortality in patients with severe chronic lung diseases. Domiciliary long-term oxygen therapy (LTOT) is an accepted treatment for patients with severe chronic respiratory failure. Our reasoning, therefore, was that if asthma is a cause of severe chronic respiratory failure in nonsmokers we should be able to find non-smoking asthmatics within a large population of patients on LTOT. The aim of our study (Asthma and Long-term Oxygen Therapy, “ALOTâ€) was to investigate the prevalence of non-smoking asthmatics in patients on LTOT in a multicentre, cross-sectional study. Methods. Between June and September 2003 we screened all subjects on long-term domiciliary oxygen therapy in three different hospitals in the North-East area of Italy (within the provinces of Ferrara and Bologna). Taken collectively, we have found one-hundred and eighty-four patients on LTOT. We have reviewed their clinical data (age, sex, smoking, history and physical examination, arterial blood gas analysis, pulmonary function). Results. 114 patients (all smokers) fulfilled the diagnostic criteria for COPD. Seventy patients (all smokers) had other diseases. We were unable to find any non-smokers in our screened population of subjects on long-term domiciliary oxygen therapy. Furthermore, there was no past history of asthma and/or acute wheezing episodes in either of the patient groups. Conclusions. This data suggests that asthma is an uncommon cause of severe chronic respiratory failure necessitating long-term domiciliary oxygen therapy in nonsmokers and supports the current consensus that asthma and COPD are different diseases with differing stages of severity and the concept that long-term avoidance of active smoking is fundamental for the prevention of severe chronic respiratory failure.

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Published
2005-06-30
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Section
Original Articles
Keywords:
Asthma, Long-Term Oxygen Therapy, Natural History, Chronic Respiratory Failure
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How to Cite
Caramori, G., M. Fabbri, D. Paioli, F. Falcone, C. Severino, G. Felisatti, O. Arar, I.M. Adcock, K. Fan Chung, P.J. Barnes, A. Ciaccia, and A. Papi. 2005. “Asthma Is Not a Common Cause of Severe Chronic Respiratory Failure in Non-Smokers: ALOT Study”. Monaldi Archives for Chest Disease 63 (2). https://doi.org/10.4081/monaldi.2005.643.

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