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Publications

Journal Article Ahead of print 1 citation

PubMed: 42413614 DOI: 10.1016/j.jaip.2026.06.041

Combined large and small airway obstruction is associated with increased exacerbation frequency and poorer symptom control in persistent asthma.

J Allergy Clin Immunol Pract

Authors: Samruddhi Lele, Anu Pillai, Musab Quayum, Michael E Wechsler, Praveen Akuthota, Ronald J Dandurand, Richard Hammond, Atanu Bhattacharjee, Francesco Menzella, Remo Poto, Pasquale Comberiati, Alvise Berti, Carlo Lombardi, Stanley P Galant, Ophir Freund, Laura Ventura, Andrea Portacci, Giovanna Elisiana Carpagnano, Valeria Ortolani, Brian Lipworth, Salman Siddiqui, Marcello Cottini, Rory Chan

Affiliations

  • University of Dundee, School of Medicine, UK.
  • Department of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA.
  • Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of California San Diego Health, San Diego, California.
  • McGill University, Faculty of Medicine and Health Sciences; Montreal Chest Institute, Meakins-Christie Labs, Oscillometry Unit and Centre for Innovative Medicine of the McGill University Health Centre and Research Institute, Montreal, Canada; Lakeshore General Hospital, Pointe-Claire, Canada; Ste-Anne Hospital, Ste-Anne-de-Bellevue, Canada.
  • Pulmonology Unit, S. Valentino Hospital, Montebelluna, TV, AULSS2 Marca Trevigiana, Italy.
  • Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy; Center for Basic and Clinical Immunology Research (CISI) - University of Naples Federico II, Naples, Italy.
  • Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Italy.
  • Center for Medical Sciences (CISMed), Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, Italy Santa Chiara Hospital, Azienda Ospedaliera Universitaria Intergata del Trentino (Asuit), Italy.
  • Departmental Unit of Allergology, Immunology and Pulmonary Diseases, Fondazione Poliambulanza, Brescia, Italy.
  • Children's Hospital of Orange County, University California, Irvine, Orange County, Calif.
  • Pulmonary Institute, Tel-Aviv Sourasky Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
  • Department of Statistical Sciences, University of Padova, Padova, Italy.
  • Institute of Respiratory Disease, Department of Translational Biomedicine and neuroscience, University "Aldo Moro", Bari, Italy.
  • Allergology and Clinical Immunology, Luigi Sacco Hospital, University Hospital and Academic Centre, Milan, Italy.
  • National Heart and Lung Institute, Imperial College London, UK.
  • Allergy and Pneumology Outpatient Clinic, Bergamo, Italy.
  • University of Dundee, School of Medicine, UK.

Abstract

BACKGROUND

Spirometry remains central to the assessment of asthma but may fail to detect small airways dysfunction (SAD), which contributes to considerable symptoms and exacerbation risk.

OBJECTIVE

We investigated whether integrating oscillometry with spirometry improves physiological phenotyping and risk stratification in asthma.

METHODS

In this retrospective multicentre study, data from 1,497 adults with asthma were analysed from the Oscillometry Asthma Registry (OAR). SAD was defined using the (Rrs5-20)/Rrs5 ratio ≥19%, and airflow obstruction as FEV 1/FVC <70%. Participants were categorised into four mutually exclusive groups: (a) Group 1 - normal oscillometry and normal spirometry; (b) Group 2 - abnormal oscillometry with normal spirometry; (c) Group 3 - normal oscillometry with abnormal spirometry; and (d) Group 4 - abnormal oscillometry and abnormal spirometry. Associations with symptom control, exacerbations, and type 2 inflammatory biomarkers were assessed using multivariable logistic regression.

RESULTS

For ≥1 exacerbation, the adjusted odds ratio (aORs) (95%CI) for Group 4 were: versus Group 1 3.19 (2.31,4.42); versus Group 2 1.99 (1.46,2.74); and versus Group 3 1.59 (1.07;2.37). Corresponding aOR values for Group 3 were: versus Group 2 1.26 (0.85,1.86); and versus Group 1 2.01 (1.37;2.94). The aOR for ≥1 exacerbation for Group 2 versus Group 1 was 1.60 (1.18,2.16). Results were similar when using FEV 1/FVC <LLN instead of traditional predicted values.

CONCLUSION

The combined use of oscillometry and spirometry identifies distinct physiological phenotypes of asthma with clinically meaningful differences in symptom burden and exacerbation risk.

MeSH

Hypersensitivity, Airway Obstruction, Spirometry, Signs And Symptoms, Asthma