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Allergy Asthma Immunology
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Allergology Review

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  Authority of Polish Society of Allergology

vol 16. no 4. December 2011  

 Original articles
Severe/difficult-to-treat bronchial asthma. Part I: Clinical, demographic and functional characteristics
Małgorzata Cieślak, Marek L. Kowalski

Introduction. Severe and difficult-to-treat asthma is associated with
significant morbidity, lower quality of life and higher health cost for the
society. Better understanding of severe/difficult-to-treat asthma phenotype,
may help to improve asthma care.
Aim of the study. We aimed to distinguish and characterize patients
with severe/difficult-to-treat (S/D) bronchial asthma.
Material and methods. The study included 210 patients with asthma
from one asthma clinic. Following 12 months of observation 109 patients
with severe/difficult-to-treat (S/D) asthma defined according to the ATS
Workshop 2000 and 101 patients with non-severe (ns mild to moderate)
form of the disease were distinguished. After one year of follow up and
verification of the diagnosis all patients were skin prick tested and spirometry
after nebulization of 2,5 mg of salbutamol was performed.
Results. Patients with S/D asthma were significantly older, were more
obese and had higher prevalence of hypersensitivity to aspirin. Female
gender, obesity, history of aspirin hypersensitivity and history of childhood
wheezing were significant risk factors for S/D asthma. The prevalence
of atopy was high and similar in both groups (72% and 80% in
S/D and nS group respectively). Baseline respiratory function (particularly
MEF 25-50%) were significantly lower in patients with S/D asthma, and
the degree of reversibility after nebulization of salbutamol was significantly
higher in this group.
Conclusions. The study documented distinct demographic, clinical and
functional characteristics of patients with severe/difficult-to-treat asthma,
which may have implications for phenotype specific management.

keywords: astma ciężka, astma trudna, nadwrażliwość na aspitynę, nebulizacja, próba rozkurczowa, severe asthma, difficult asthma, aspirin hypersensitivity, airway reversibility, bronchodilatation test

pages: from 186 to 193

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