Proceedings of the American Thoracic Society
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The Proceedings of the American Thoracic Society 6:707-711 (2009)
© 2009 The American Thoracic Society
doi: 10.1513/pats.200908-085DP
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Epidemiology of the Origins of Airflow Limitation in Asthma

Stefano Guerra1,2 and Fernando D. Martinez1

1 Arizona Respiratory Center, University of Arizona, Tucson, Arizona; and 2 Center for Research in Environmental Epidemiology, Barcelona, Spain

Correspondence and requests for reprints should be addressed to Fernando D. Martinez, M.D., Arizona Respiratory Center, 1501 N. Campbell Ave., Suite 2349, PO Box 245030, Tucson, AZ 85724-5030. E-mail: Fernando{at}arc.arizona.edu

ABSTRACT

There is now conclusive evidence that, as a group, subjects with asthma have lower levels of lung function as compared with their peers and that a significant proportion of subjects with persistent asthma are at risk of developing non–fully reversible airflow limitation, the clinical hallmark of chronic obstructive pulmonary disease. Although at the population level the most conspicuous form of airflow limitation in asthma seems to be that of subjects who wheeze during the first years of life and whose symptoms persist into adult life, asthma-related lung deficits can be related to both acquired deficits in growth of lung function in childhood and steeper decline of lung function in adult life. These trajectories of lung function are likely to differ across subgroups of individuals with asthma, suggesting that different windows of opportunity may exist to modify the natural course of the disease before irreversible deficits are established. These observations indicate the importance of identifying biomarkers that can be used to target children and adults with asthma at increased risk for airflow limitation and determining whether pharmacological interventions can protect these patients from the development of chronic obstructive pulmonary disease.

Key Words: asthma • chronic obstructive pulmonary disease • lung function • airflow limitation • FEV1






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