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Long-Term Outcomes of Acute Irritant-induced Asthma

¹ Axe de Recherche en Santé Respiratoire, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec

Correspondence and requests for reprints should be addressed to Jean-Luc Malo, M.D., Department of Chest Medicine, Hôpital du Sacré-Coeur de Montréal, 5400 West Gouin Blvd, Montreal, PQ, H4J 1C5 Canada. E-mail: malojl{at}meddir.umontreal.ca

Rationale: The long-term outcomes of acute irritant-induced asthma (IIA) are mostly unknown.

Objectives: To study the long-term outcomes of IIA.

Methods: We reassessed 35 subjects who experienced IIA at a mean interval of 13.6 ± 5.2 years.

Measurements and Main Results: The causal agent was chlorine in 20 cases (57%). At diagnosis, the mean ± SD FEV₁ was 74.5 ± 19.5% predicted, and all subjects showed bronchial hyperresponsiveness. At reassessment, all subjects reported respiratory symptoms, and 24 (68%) were on inhaled steroids. There were no significant improvements in FEV₁ and FEV₁/FVC values. Twenty-three subjects had a methacholine test, and only six subjects had normal levels of responsiveness. Of the remaining 12 subjects, six had improvement in FEV₁ after bronchodilator 10%. In samples of induced sputum obtained from 27 subjects, six had eosinophils 2%. Levels of inflammatory and remodeling mediators were higher than in control subjects but were no different from subjects with occupational asthma due to sensitization. Quality of life score was 4.4 ± 1.5 on a 0 (worst) to 7 (best) scale. Twelve subjects had an abnormal depression score.

Conclusions: This study provides the first evidence of significant long-term impact of acute IIA on various outcomes.

Key Words: occupational asthma • reactive airways dysfunction syndrome • inflammation, remodeling

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject The long-term clinical, psychological, and pathological outcomes of acute irritant-induced asthma are mostly unknown. What This Study Adds to the Field Acute irritant-induced asthma has significant long-term impact on pulmonary function, quality of life and psychological parameters.

 

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