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      Study of correlation between forced vital capacity and demand for healthcare services in severe asthmatics

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          Abstract

          Background

          Involvement of the small airways may be related to increased severity and increased demand for health care services and incurring in high costs, private or for the healthcare system. The hyperinflation consequent to this involvement reduces lung volumes, such as FVC, FEV 1 and SVC. The aim of this study was to evaluate the correlation between the predicted values of FVC, FEV 1 and SVC with the demand for healthcare services by severe asthmatics.

          Methods

          We retrospectively evaluated in order of arrival, the medical records of 98 patients with severe asthma, in step 4 treatment in the intercritical period of the disease, correlating the number of times each patient sought health care services represented by admissions to the ER, ICU and hospital wards due to asthma, in the year before the last spirometry and the predicted values of FVC, FEV 1 and SVC.

          Results

          Our sample showed a clear and significant negative correlation between the predicted values of FVC, FEV 1 and SVC and demand for healthcare services.

          Conclusion

          For this sample we conclude, that reduced forced vital capacity correlated with asthma severity, defined by greater demand for care in the ER, ICU and hospital ward and was more evident in women.

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          Most cited references19

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          Evidence that severe asthma can be divided pathologically into two inflammatory subtypes with distinct physiologic and clinical characteristics.

          S E Wenzel, L B Schwartz, E L Langmack … (1999)
          The mechanisms associated with the development of severe, corticosteroid (CS)-dependent asthma are poorly understood, but likely heterogenous. It was hypothesized that severe asthma could be divided pathologically into two inflammatory groups based on the presence or absence of eosinophils, and that the inflammatory subtype would be associated with distinct structural, physiologic, and clinical characteristics. Thirty-four severe, refractory CS-dependent asthmatics were evaluated with endobronchial biopsy, pulmonary function, allergy testing, and clinical history. Milder asthmatic and normal control subjects were also evaluated. Tissue cell types and subbasement membrane (SBM) thickness were evaluated immunohistochemically. Fourteen severe asthmatics [eosinophil (-)] had nearly absent eosinophils (< 2 SD from the normal mean). The remaining 20 severe asthmatics were categorized as eosinophil (+). Eosinophil (+) severe asthmatics had associated increases (p < 0.05) in lymphocytes (CD3+, CD4+, CD8+), mast cells, and macrophages. Neutrophils were increased in severe asthmatics and not different between the groups. The SBM was significantly thicker in eosinophil (+) severe asthmatics than eosinophil (-) severe asthmatics and correlated with eosinophil numbers (r = 0.50). Despite the absence of eosinophils and the thinner SBM, the FEV(1) was marginally lower in eosinophil (-) asthmatics (p = 0.05) with no difference in bronchodilator response. The eosinophil (+) group (with a thicker SBM) had more intubations than the eosinophil (-) group (p = 0.0004). Interestingly, this group also had a decreased FVC/slow vital capacity (SVC). These results suggest that two distinct pathologic, physiologic, and clinical subtypes of severe asthma exist, with implications for further research and treatment.
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            Proceedings of the ATS workshop on refractory asthma: current understanding, recommendations, and unanswered questions. American Thoracic Society.

            C. Irvin, A’s Society, SJ Szefler … (2000)
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              The ENFUMOSA cross-sectional European multicentre study of the clinical phenotype of chronic severe asthma. European Network for Understanding Mechanisms of Severe Asthma.

              ALBERTO PAPI (2003)
              Since severe asthma is a poorly understood, major health problem, 12 clinical specialist centres in nine European countries formed a European Network For Understanding Mechanisms Of Severe Asthma (ENFUMOSA). In a cross-sectional observational study, a total of 163 subjects with severe asthma were compared with 158 subjects whose asthma was controlled by low doses of inhaled corticosteroids (median dose of beclomethasone equivalents 666 microg). Despite being treated with higher doses of inhaled corticosteroids (median dose 1773 microg) and for a third of the severe asthmatics also being treated with regular, oral-steroid therapy (median daily dose 19 mg), the subjects with severe asthma met the inclusion criteria. The criteria required subjects to have undergone at least one asthma exacerbation in the past year requiring oral steroid treatment. Females dominated the severe asthma group (female/male ratio 4.4:1 versus 1.6:1 in the controlled asthmatics), and compared with controlled asthmatics, they had a predominantly neutrophilic inflammation (sputum neutrophils, 36 versus 28%) and evidence of ongoing mediator release but less atopy. From these findings and other physiological and clinical data reported in this paper, it is suggested that severe asthma might be a different form of asthma rather than an increase in asthma symptoms. The findings prompt for longitudinal studies and interventions to define the mechanisms in severe asthma.
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                Author and article information

                Contributors
                J.F. Castelluccio: pos.graduacao@fcmsantacasasp.edu.br
                R. Stirbulov: stirbulov@uol.com.br
                E.A. Perez: dudu.perez@hotmail.com
                J.C.M. Oliveira: ipulmao@terra.com.br
                C.F. Donner: cfdonner@mondomedico.it
                L.V.F. Oliveira: (55 -11) 991702292 , oliveira.lvf@uninove.br
                Z. Rasslan: ziedrasslan@uol.com.br
                Journal
                Journal ID (nlm-ta): Multidiscip Respir Med
                Journal ID (iso-abbrev): Multidiscip Respir Med
                Title: Multidisciplinary Respiratory Medicine
                Publisher: BioMed Central (London )
                ISSN (Print): 1828-695X
                ISSN (Electronic): 2049-6958
                Publication date (Electronic): 22 July 2015
                Publication date PMC-release: 22 July 2015
                Publication date Collection: 2015
                Volume: 10
                Issue: 1
                Electronic Location Identifier: 22
                Affiliations
                [ ]Assistant Professor Internal Medicine Department, Santa Casa School of Medicine and Hospitals of São Paulo, São Paulo (SP), Brazil
                [ ]Associate Professor Internal Medicine Department – Pneumology, Santa Casa School of Medicine and Hospitals of São Paulo, São Paulo (SP), Brazil
                [ ]Master Degree Program in Research in Surgery of Santa Casa School of Medicine of Sao Paulo (FCMSCSP), Sao Paulo (SP), Brazil
                [ ]Rehabilitation Sciences PhD Program, Nove de Julho University, Sao Paulo, Brazil
                [ ]Mondo Medico, Multidisciplinary and Rehabilitation Outpatient Clinic, Borgomanero, NO Italy
                [ ]Rehabilitation Sciences Master and PhD Program, Nove de Julho University, Sao Paulo, Brazil
                [ ]Assistant Professor Internal Medicine Department, Santa Casa School of Medicine and Hospitals of São Paulo, São Paulo (SP), Brazil
                [ ]Rua Itapicuru, 380 apto 111 Perdizes, CEP 05006-000 Sao Paulo, SP Brazil
                Article
                Publisher ID: 20
                DOI: 10.1186/s40248-015-0020-5
                PMC ID: 4508817
                SO-VID: e5de4e34-154b-4cbf-9a70-edbd716c9b8a
                Copyright © © Castelluccio et al. 2015
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 11 March 2015
                Date accepted : 3 July 2015
                Categories
                Subject: Original Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2015

                ScienceOpen disciplines: Respiratory medicine
                Keywords: asthma,healthcare utilization,vital capacity
                Data availability:
                ScienceOpen disciplines: Respiratory medicine
                Keywords: asthma, healthcare utilization, vital capacity

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