Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr 5:18:491-505.
doi: 10.2147/JAA.S497218. eCollection 2025.

Peripheral Airway Obstruction in Association with Symptoms and Quality of Life in Asthma

Georgia Papapostolou  1 , Abir Nasr  1 , Linnea Jarenbäck  1 , Kerstin Romberg  2 , Alf Tunsäter  1 , Jaro Ankerst  1 , Leif Bjermer  1 , Ellen Tufvesson  1
Affiliations

Peripheral Airway Obstruction in Association with Symptoms and Quality of Life in Asthma

Georgia Papapostolou et al. J Asthma Allergy. .

Abstract

Introduction: Forced Oscillation Technique (FOT) is increasingly used to measure obstruction in the airways; however, the association between airway obstruction and the actual symptom burden in asthma is not known. Therefore, we aimed to investigate central and peripheral airway obstruction, measured by FOT, in association to symptoms and quality of life in asthma.

Methods: 319 asthma patients were recruited and answered questionnaires focusing on symptoms (ACT, ACQ, Nijmegen, HADS and SNOT-22) and quality of life (MiniAQLQ and MiniRQLQ) and performed FOT measurements estimating airway resistance (R5: total resistance, R19: central resistance, R5-R19: peripheral resistance) and reactance (X5) during inspiration and expiration.

Results: Asthma groups classified based on ACT score cut-off points at 16, 20, and 25 showed higher R5, R5-R19, and lower X5 with increasing symptoms, which was not evident when applying a cut-off of only 20. ACQ-5 cut-offs at 0.75 and 1.5 captured differences in R5 and X5, whereas a Nijmegen cut-off of 23 showed differences in R5 and R19. The total scores from most questionnaires (except for the HADS and SNOT-22) correlated with many of the FOT results, but there were different patterns of correlation between airway obstruction and symptoms in uncontrolled and controlled asthma. Additionally, specific questions were associated with airway obstruction.

Conclusion: The increasing symptoms in patients with asthma assessed using questionnaires correlated well with predominantly increasing peripheral airway obstruction. A correlation also exists with the Nijmegen score, which is not specific to asthma. The cut-off points used to define asthma control may capture peripheral airway dysfunction.

Keywords: airway obstruction; asthma; quality of life; symptom.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Frequency distribution of number of subjects with asthma with the separate scores from ACT (A), ACQ-5 (B) and MiniAQLQ (C) grouped according to uncontrolled (black bars) or controlled (grey bars) asthma based on ACT score < or ≥20, respectively. Dotted line separates uncontrolled and controlled disease (A), and well controlled, partly controlled and poorly controlled based on ACQ (B).
Figure 2
Figure 2
Frequency distribution of number of subjects with asthma with the separate scores from HADS (A) and Nijmegen (B) scores grouped according to uncontrolled (black bars) or controlled (grey bars) asthma based on ACT score < or ≥20.
Figure 3
Figure 3
Box-plots of R5 (A), R19 (B), R5-R19 (C) and X5 (D) in groups of asthma separated according to ACT=25, ACT=20-24, ACT=16-19 and ACT=<16. *=p<0.05, **=p<0.01 from statistical analyses using Kruskal–Wallis test for overall comparisons followed by Dunn’s test for multiple comparisons between separate groups.
Figure 4
Figure 4
Box-plots of R5 (A), R19 (B), R5-R19 (C) and X5 (D) in groups of asthma separated according to ACQ<0.75, ACQ=0.75–1.5 and ACQ>1.5. *=p<0.05, **=p<0.01 from statistical analyses using Kruskal–Wallis test for overall comparisons.
Figure 5
Figure 5
Box-plots of R5 (A), R19 (B), R5-R19 (C) and X5 (D) in groups of asthma separated according to Nijmegen ≤ or >23. *=p<0.05, ***=p<0.001 from statistical analyses using Mann–Whitney U-test for comparisons between separate groups.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. GINA. GINA main report 2023. Available from: https://ginasthma.org/wp-content/uploads/2023/07/GINA-2023-Full-report-2.... Accessed March 20, 2025.
    1. Heijkenskjold Rentzhog C, Janson C, Berglund L, et al. Overall and peripheral lung function assessment by spirometry and forced oscillation technique in relation to asthma diagnosis and control. Clin Experimental Allergy. 2017;47(12):1546–1554. doi:10.1111/cea.13035 - DOI - PubMed
    1. Wilson SR, Rand CS, Cabana MD, et al. Asthma outcomes: quality of life. J Allergy Clin Immunol. 2012;129(3 Suppl):S88–123. doi:10.1016/j.jaci.2011.12.988 - DOI - PMC - PubMed
    1. Apfelbacher CJ, Hankins M, Stenner P, Frew AJ, Smith HE. Measuring asthma-specific quality of life: structured review. Allergy. 2011;66(4):439–457. doi:10.1111/j.1398-9995.2010.02500.x - DOI - PubMed
    1. Lurie A, Marsala C, Hartley S, Bouchon-Meunier B, Dusser D. Patients’ perception of asthma severity. Respir Med. 2007;101(10):2145–2152. doi:10.1016/j.rmed.2007.05.027 - DOI - PubMed

LinkOut - more resources