Clinical characteristics of 41 patients with intractable asthma

Objective To explore the clinical characteristics of intractable asthma,and to provide new knowledge for diagnosis and treatment of the disease.Methods Forty one patients with intractable asthma,admitted to the Institute of Respiratory Disease,Xinqiao Hospital of Third Military Medical University from Jan.2009 to Dec.2010,were included in present study.Spirometry tests were performed for all the 41 patients.Cell classification and counting were done in the induced sputum of 37 patients,and 34 patients underwent high-resolution chest computed tomography(HRCT).Results Incomplete reversibility of airflow obstruction(FEV1/FVC 0.03 of the total cells),13(35.1%) and increased neutrophils( > 0.61 of total cells),6(16.2%) showed increased both eosinophils and neutrophils,and only that of one patient showed normal percentage of the eosinophils and neutrophils.Chest HRCT of 34 patients showed thickening of bronchial wall in visible segment in 28 cases(82.3%),and in 22 cases(64.7%) thickening of bronchial wall in secondary segments was accompanied with narrowed bronchus lumen,cylindrical bronchiectasis was predominant in 7 patients,and centrilobular emphysema was seen in 5 patients.Conclusion Airway remodeling,incomplete reversibility of airflow obstruction,airway inflammation appear to be the major clinical characteristics of intractable asthma.Combined use of chest HRCT,spirometry test,and cellular analysis of induced sputum may be helpful for identifying intractable asthma,and they provide the basis for individualized strategies to manage the disease.