Persistent airflow limitation (PAL) is an asthma phenotype defined as airflow obstruction that remains after the use of a β2-agonist. Past studies on PAL have included small populations and were mostly restricted to severe asthma. Kole et al ( Lancet Respir Med 2023;11:55) conducted a post hoc analysis to investigate the determinants and outcomes of PAL in patients with asthma who were included in the Assessment of Small Airways Involvement in Asthma (ATLANTIS) study, a multicentric cohort with 1-year follow-up. PAL was defined by authors as a postbronchodilator FEV1/FVC less than the lower limit of normal at baseline and was identified in 33% of the 760 patients in ATLANTIS. PAL was an independent predictor of exacerbations (HR 1.73, 95% CI 1.22 to 2.48) and was associated with an earlier diagnosis, current smoking and markers of eosinophilic inflammation. In addition, PAL was identified in 21% of those classified as Global Initiative for Asthma (GINA) steps 1–2 (ie, mild asthma), in whom it was also an independent predictor of exacerbations (HR 5.55, 95% CI 1.83 to 16.86). In severe asthma, patients with PAL have been shown to respond well to add-on treatment with long-acting muscarinic antagonists. Despite the potential confounding …

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期刊俱乐部

持续性气流受限 (PAL) 是一种哮喘表型，定义为使用 β2 激动剂后仍然存在的气流阻塞。过去关于 PAL 的研究只纳入了少数人群，并且大多仅限于严重哮喘。Kole 等人 (Lancet Respir Med 2023;11:55) 进行了事后分析，以调查哮喘患者 PAL 的决定因素和结果，这些患者被纳入哮喘小气道受累评估 (ATLANTIS) 研究，这是一个多中心队列随访 1 年。PAL 被作者定义为支气管扩张剂后 FEV1/FVC 低于基线正常下限，在 ATLANTIS 的 760 名患者中有 33% 的患者被确诊。PAL 是恶化的独立预测因子（HR 1.73，95% CI 1.22 至 2.48）并且与早期诊断相关，当前吸烟和嗜酸性粒细胞炎症的标志物。此外，在 21% 的被归类为全球哮喘倡议 (GINA) 第 1-2 步（即轻度哮喘）的患者中发现 PAL，在这些患者中，PAL 也是恶化的独立预测因子（HR 5.55，95% CI 1.83 至16.86）。在重度哮喘中，已证明 PAL 患者对长效毒蕈碱拮抗剂的附加治疗反应良好。尽管有潜在的混淆……