Am. J. Respir. Crit. Care Med., Volume 159, Number 5, May 1999, 1545-1550

Evidence of Acinar Airway Involvement in Asthma

SYLVIA VERBANCK, DANIËL SCHUERMANS, MARC NOPPEN, ALAIN VAN MUYLEM, MANUEL PAIVA, and WALTER VINCKEN

Respiratory Division, Academic Hospital, Vrije Universiteit Brussel, Brussels; Respiratory Division, Academic Hospital Erasme, Université Libre de Bruxelles, Brussels; and Laboratoire de Physique Biomédicale, Université Libre de Bruxelles, Brussels, Belgium

We investigated acinar airway involvement in 20 patients with stable asthma, using the phase III slope analysis of the multiple breath N₂ washout previously applied in a group of patients with COPD (Am. J. Respir. Crit. Care Med. 1998;157:1573-1577). This technique quantifies severity of conductive and acinar components of ventilation maldistribution separately, through indices S_cond and S_acin, which increase when respective ventilation inhomogeneities increase. We also investigated the effect of salbutamol inhalation on S_cond and S_acin in patients with asthma and compared it with that obtained in patients with COPD. Baseline measurements in the patients with asthma show that (1) acinar ventilation inhomogeneity was indeed abnormal in patients with asthma (S_acin = 0.195 ± 0.026 L¹) despite the normal diffusing capacity in this group; S_acin values were intermediate between those obtained in unaffected individuals and patients with COPD, and that (2) conductive ventilation inhomogeneity was abnormal in the patients with asthma (S_cond = 0.076 ± 0.006 L¹) but similar to that obtained in the patients with COPD. Measurements after salbutamol inhalations showed significant changes in S_cond and S_acin only in the patients with asthma (p < 0.001). This study primarily demonstrated significant, but partially reversible, acinar airway impairment in patients with asthma, as compared with the more severe baseline acinar airway impairment in patients with COPD, which was not reversible after salbutamol inhalation.

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