Thorax 58:322-327 doi:10.1136/thorax.58.4.322
  • Asthma

Risk factors associated with the presence of irreversible airflow limitation and reduced transfer coefficient in patients with asthma after 26 years of follow up

  1. J M Vonk1,
  2. H Jongepier2,
  3. C I M Panhuysen3,
  4. J P Schouten1,
  5. E R Bleecker4,
  6. D S Postma5
  1. 1Department of Epidemiology and Statistics, University of Groningen, The Netherlands
  2. 2Beatrixoord Hospital, Haren, The Netherlands
  3. 3Boston University Schools of Medicine and Public Health, Boston, MA, USA
  4. 4University of Maryland, Baltimore, Maryland, USA
  5. 5Department of Pulmonology, University Hospital Groningen, The Netherlands
  1. Correspondence to:
    Professor D S Postma, Department of Pulmonology, University Hospital, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
  • Accepted 16 December 2002
  • Revised 7 December 2002


Background: Childhood asthma is generally believed to be a disorder with a good prognosis. However, some asthmatics develop irreversible airway obstruction, probably as a result of airway remodelling.

Methods: After 21–33 years, 228 adults (aged 13–44 years at baseline) with a history of asthma were re-examined to assess risk factors for the development of irreversible airway obstruction (IAO, forced expiratory volume in 1 second (FEV1) <80% predicted and reversibility <9% predicted) and a reduced postbronchodilator transfer coefficient (carbon monoxide transfer factor/alveolar volume, <80% predicted), both characteristics of COPD.

Results: At follow up, 41% did not have airway obstruction (NAO), 43% had reversible airway obstruction (RAO), and 16% had IAO; 23% had a reduced transfer coefficient. Patients with RAO had asthma-like characteristics (wheezing, asthma attacks, bronchial hyperresponsiveness (BHR)) while patients with IAO had COPD-like symptoms (cough, phlegm, dyspnoea) at follow up. The development of IAO is determined by a lower FEV1, less reversibility of airway obstruction and, surprisingly, less severe BHR at initial screening. Eighty percent of the patients with asthma who used anti-inflammatory medication still had airway obstruction, but IAO developed less frequently. Smoking was associated with a reduced transfer coefficient but not with the development of IAO. Female sex was associated with a reduced transfer coefficient, whereas corticosteroid use was not.

Conclusions: Although IAO and a low transfer coefficient are both characteristics of COPD, they represent distinct entities in adult asthmatics in terms of symptomatology, aetiology, and probably in therapeutic approaches and disease prevention.