THU0421 Prevalence and clinical correlates of small airway obstruction in patients with systemic sclerosis

2018 
Background Small airways are usually defined as non-cartilaginous airways with an internal diameter Objectives To assess prevalence and clinical correlates of SAO in patients with systemic sclerosis (SSc). Methods 69 consecutive patients with SSc (63 women and 6 men) were included in this study. Patients with previously diagnosed bronchiectasis, COPD or asthma were excluded. Forty two (60.9%) patients had limited cutaneous SSc, whilst 27 (39.1%) of patients had diffuse form of the disease. Seventeen patients (24.6%) were tobacco-smokers, 52 (75.4%) were nonsmokers. Lung function tests, including assessment of lung diffusing capacity, were performed in all patients. Patients were considered to have small airway obstruction (SAO) when Maximum Expiratory Flow at 25% of the forced vital capacity (MEF25) was lower than 60% as predicted. We assessed the relationship of SAO in our patients with large airway obstruction, decreased lung diffusing capacity, disease duration, disease subtype, scleroderma-specific antibodies and smoking. Results SAO was noticed in 46/69 (66.6%) of patients with SSc. Restrictive lung disease was found in 4/69 (5.8%), obstruction of large airways in 18/69 (26.1%) and decreased lung diffusing capacity in 47/69 (68.1%) of patients. No difference in gender, age, disease duration, disease form and scleroderma-specific antibodies was found between patients with and without SAO. 18/46 (39.1%) patients with SAO had decreased FEV1 and FEV1/FVC, indicating presence of coexistent large airway obstruction. Indeed, all patients with signs of obstructive lung disease on spirometry, had associated SAO. Moreover, MEF25 correlated significantly with FEV1 (ρ=0.54, p Conclusions Patients with SSc have commonly SAO. It can be considered as clinical feature of undiagnosed asthma or COPD, if associated with large airway obstruction, especially in tobacco-smokers. On the other hand, isolated SAO or associated with decreased lung diffusing capacity was found to be not related to smoking, and may indicate a possible prominent bronchiolar involvement within SSc related interstitial lung disease. Disclosure of Interest None declared
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