Long-term observations of the clinical course after step down of corticosteroid inhalation therapy in adult chronic asthmatics: correlation with serum levels of eosinophil cationic protein

BACKGROUND: Symptoms often deteriorate in well-controlled asthmatics after a step down in inhaled beclomethasone dipropionate (iBDP) therapy if the serum concentration of eosinophil cationic protein (sECP) is high. This deterioration is significantly abrogated by pranlukast, a leukotriene receptor antagonist, or by seratrodast, a thromboxane A2 receptor antagonist. However, these results were based on short-term (less than 6 months) observations. METHODS: We studied 35 well-controlled adult asthmatics. We assigned the patients into different groups according to their sECP levels before the step down: (i) group A, sECP < 25 microg/L; (ii) group B, sECP > or = 25 microg/L; and (iii) group C, sECP > or = 25 microg/L but patients treated with pranlukast or seratrodast. We began the study with a step down in iBDP therapy (initial step down), then followed the clinical course of the asthma for 2 years. During the study period, we decreased, increased or maintained the iBDP dose on the basis of the stepwise approach described in the National Institutes of Health guidelines. We monitored the time and frequency of exacerbation and evaluated the iBDP dose required to control the asthma symptoms. RESULTS: The rates of exacerbation after the step down were high in groups A and B. In group A, the conditions were again qualified for the step down in all patients, but this was not the case for most group B patients. From 15 to 21 months after the initial step down, the average dose of iBDP required to control symptoms was significantly higher in group B than in group A patients (P = 0.0127-0.0373). The exacerbation rate in group C after 12 months tended to be lower than in the other two patient groups (P = 0.0743). In group C, the average dose of iBDP from 9 to 24 months after the initial step down was significantly lower than before the step down (P < 0.0001) and was not significantly different from the mean dose of iBDP in groups A or B. CONCLUSIONS: High sECP in well-controlled asthma may indicate the necessity for a higher iBDP dose over a long period than when the sECP concentration is not high. Even if sECP is high, pranlukast or seratrodast help to prevent exacerbation of asthma and enable successful step down in iBDP therapy for at least 2 years thereafter.     

Furosemide Given by Inhalation Ameliorates Acute Exacerbation of Asthma

Previous studies have suggested that inhaled furosemide may have a protective effect against a wide variety of bronchoconstrictor agents, but a therapeutic effect has not been established in acute exacerbation of asthma. The purpose of this study was to investigate whether inhaled furosemide would exhibit any therapeutic benefit in acute asthma. We conducted a double-blind, placebo-controlled, randomized study in 40 patients with acute mild or moderate exacerbation of asthma. All patients received intravenous (IV) aminophylline 250 mg for 90 min and IV hydrocortisone 100 mg at entry. After randomization, 3 patients were excluded from the final analysis. At 30 min after starting IV aminophylline, 20 patients were given inhaled furosemide 20 mg and 17 patients received normal saline as placebo-control. Both inhalations were given by a jet nebulizer. The baseline forced expiratory volume at 1 sec (FEV₁), peak expiratory flow rate (PEFR), and serum concentration of theophylline did not differ between the two groups. An increase in FEV₁ in the furosemide group by 28.2 ± 5.9% (mean ± SE) was noted at 60 min, and this was significantly higher than in the control group. PEFR at 60 min was also significantly higher in the furosemide group than in control group. We conclude that inhaled furosemide has a bronchodilator effect on mild to moderate exacerbation of asthma when it is used with IV theophylline. Inhaled furosemide may benefit certain acute asthma patients, especially those suffering complications from the adverse effects of β₂-agonists.     

Serum eosinophil cationic protein for predicting the prognosis of a step-down in inhaled corticosteroid therapy in adult chronic asthmatics.

We investigated whether the serum concentration of eosinophil cationic protein (s-ECP) can be used to determine when a step-down in inhaled corticosteroid therapy is indicated for patients with chronic asthma. A total of 24 adult patients, whose symptoms were well controlled with inhaled beclomethasone dipropionate (iBDP), were studied. The dosage of iBDP was reduced by half once a month until the dose reached one-quarter of the original level. s-ECP and blood eosinophil counts were determined once a month before and during the 6-month period after the step-down. In 12 patients, moderate and frequent exacerbation occurred, thus requiring a return to the initial or twice the initial dose of iBDP. Thus, the step-down here was defined as unsuccessful. In the remaining 12 patients, the symptoms were stable over the course of the 6 months, and the step-down was defined as successful. s-ECP correlated with eosinophil counts in peripheral blood (EOS) in both the successful and the unsuccessful groups. Although EOS before the step-down did not differ significantly between the two groups, s-ECP was significantly higher in the unsuccessful group (mean 35.7 microg/L) than in the successful group (mean 17.0 microg/L, p < 0.03). Thus, s-ECP appears to be a useful marker for determining when a step-down in iBDP therapy is indicated, and thus may contribute to successful long-term management of chronic asthma.     

咳嗽变异性哮喘患者疗效与布地奈德福莫特罗疗程的相关性研究

背景 咳嗽变异性哮喘(CVA)是引起成年人慢性咳嗽的主要原因,布地奈德福莫特罗作为治疗此病的重要药物,其最佳疗程目前尚无统一定论,如何在保证治疗安全性的同时尽可能使患者获益是当前临床研究热点和难点.目的 探讨CVA患者疗效与布地奈德福莫特罗疗程的相关性.方法 选取廊坊市人民医院门诊2018年8月至2020年3月收治的C...     

The Impact of Spirometry on Pediatric Asthma Diagnosis and Treatment

Research has shown that spirometry is underutilized in the clinical setting. This study profiles the use of spirometry in an asthma management program at an inner-city community health clinic. Eligible subjects included 56 children who presented with an acute asthma exacerbation. Physicians recorded patient diagnosis before and after viewing spirometry. Bivariate and multivariate analysis was used to determine associations between symptoms and forced expiratory volume in 1 second (FEV₁). Physicians changed 30.4% of patients' treatment plans after viewing spirometry results. Wheezing was significantly associated with FEV₁ in bivariate analysis; however, multivariate modeling failed to identify significant relationships. The use of spirometry influenced patient diagnosis and treatment.     

成人支气管哮喘患者血清25-羟维生素D水平与肺通气功能、最小诱发累积剂量的相关性研究

背景 维生素D(VitD)是一种有效的免疫调节剂,其缺乏与支气管哮喘(以下简称哮喘)患者气道炎症、病情加重和预后不良有关.目前,成人哮喘与VitD相关性的研究报道较少,且研究结果并不一致.目的 探讨成人哮喘患者血清25-羟维生素D〔25(OH)D〕水平与肺通气功能、最小诱发累积剂量(Dmin)的相关性.方法 本研究为回...     

What Predicts Change in Pulmonary Function and Quality of Life in Asthma or COPD?

Information about predictors of decline in pulmonary function (forced expiratory volume in 1 second [FEV₁]) or health-related quality of life (HRQoL) in patients with asthma or (chronic obstructive pulmonary disease [COPD]) might help to determine those who need additional care. A 2-year prospective cohort study was conducted among 380 asthma and 120 COPD patients. In both asthma and COPD patients, a 2-year change in FEV₁ was only weakly associated with a 2-year change in HRQoL (r = .0.19 and 0.24, respectively). In both groups, older age, living in an urban environment, and a lower peak expiratory flow rate (PEFR) at baseline were associated with a decline in FEV₁. Additional predictors of FEV₁ decline were greater body weight, less chronic cough or sputum production, and less respiratory symptoms in asthma patients and current smoking in COPD patients. A decline in HRQoL was associated with older age, non-compliance with medication, more dyspnea, and a lower PEFR in asthma patients and with male gender, lower education, lower body weight, more dyspnea, and more respiratory symptoms in COPD patients. Our results show that FEV₁ and HRQoL appear to represent different disease aspects influenced by different predictors.     

血清维生素D、MMP-9表达水平对哮喘患儿严重程度的评估及临床意义

目的探讨血清维生素D、基质金属蛋白酶-9(MMP-9)表达水平对哮喘患儿严重程度的评估价值。 方法选择2018年8月至2019年8月成都市妇女儿童中心医院呼吸科门诊收治入院的56例哮喘急性发作期患儿作为研究对象,根据病情严重程度将患儿分为轻度组14例、中度组25例、重度组17例,选择同期在我院儿保科体检合格的34例儿童作为对照组。所有受试对象入组后24 h内抽取静脉血测定血清中维生素D及MMP-9水平,并进行肺功能检查。比较四组研究对象的一般情况、肺功能指标、血清中维生素D及MMP-9水平,对血清中维生素D、MMP-9水平与肺功能和病情严重程度进行相关性分析。 结果患儿第1 s用力呼气容积(FEV₁)、用力肺活量(FVC)、FEV₁/FVC、25%用力呼气流量(FEF₂₅)、50%用力呼气流量(FEF50)及75%用力呼气流量(FEF₇₅)明显小于对照组(P<0.05);随着病情程度加重,FEV₁、FVC、FEV₁/FVC、FEF₂₅、FEF₅₀及FEF₇₅逐渐减小(P<0.05);患儿血清中维生素D水平明显低于对照组,血清中MMP-9水平明显高于对照组(P<0.05);随着病情程度加重,血清中维生素D水平逐渐降低,血清中MMP-9水平逐渐升高(P<0.05);血清中维生素D水平与FEF₂₅、FEF₅₀及FEF₇₅呈正相关,血清中MMP-9水平与FEF₂₅、FEF₅₀及FEF₇₅呈负相关(P<0.05);血清中维生素D水平与病情严重程度呈负相关;血清中MMP-9水平与病情严重程度呈正相关。 结论哮喘患儿血清中维生素D水平随病情程度逐渐下降,MMP-9水平随病情程度逐渐上升,同时其水平与肺功能密切相关,加强对哮喘患儿血清维生素D及MMP-9的监测对病情评估具有重要的临床意义。     

EOS、总IgE与儿童哮喘严重程度和肺功能的相关性

目的 分析血嗜酸性粒细胞(EOS)、总IgE与儿童哮喘严重程度和肺功能的相关性。方法 选择2018年1月至2021年1月我院收治并确诊的55例支气管哮喘患儿,根据病情严重程度分为轻度组18例、中度组22例、重度组15例。对比不同病情严重程度组儿童血清EOS、总IgE、FeNO及肺功能第1秒用力呼气容积占预测值百分比(FEV₁%pred)、呼气峰值流速(PEF)和用力肺活量(FVC)水平变化;观察给予吸入性糖皮质激素(ICS)治疗前后,哮喘组儿童上述指标变化情况;采用Spearman秩相关和Pearson相关性分析血清EOS、总IgE与儿童哮喘FeNO、病情严重程度及肺功能的相关性。结果 哮喘组儿童FeNO及血EOS%、总IgE水平升高,肺功能指标FEV₁%pred、PEF、FVC明显降低(P<0.05);重度哮喘组上述指标高于/低于中度组,中度组高于/低于轻度组(P<0.05)。ICS治疗后,哮喘组儿童FeNO及血EOS%、总IgE水平较治疗前降低,肺功能指标升高,治疗前后差异有统计学意义(P<0.05)。儿童哮喘血EOS%...     

雾化吸入沙丁胺醇联合无创机械通气治疗慢性阻塞性肺疾病急性发作的临床分析

目的探讨雾化吸入沙丁胺醇联合无创机械通气治疗方案对慢性阻塞性肺疾病急性发作(AECOPD)患者支气管舒张反应、气体交换参数的影响。 方法选取我院80例(AECOPD)患者,随机分为2组,对照组38例,实验组42例,对照组采用无创机械通气疗法,实验组于其基础上雾化吸入沙丁胺醇,比较2组治疗前后肺功能[用力肺活量(FVC)、1 s用力呼气量(FEV₁)、FEV₁/FVC]、气体交换参数[每分钟通气量(VE)、潮气量(VT)、呼吸频率(RR)]、支气管舒张试验反应[FVC改变量(ΔFVC)与改善率、FEV₁改变量(ΔFEV1)与改善率]、症状与体征消失时间及不良反应情况。 结果实验组治疗后FVC、FEV₁、FEV₁/FVC显著高于对照组(P<0.05);实验组治疗后VE、VT、RR显著高于对照组(P<0.05);2组ΔFEV1与改善率比较无显著差异(P>0.05),实验组ΔFVC与改善率明显小于对照组(P<0.05);实验组咳嗽、喘憋、发绀、肺啰音消失时间明显短于对照组(P<0.05);2组不良反应总发生率比较无显著差异(P>0.05)。 结论雾化吸入沙丁胺醇联合无创机械通气可有效改善AECOPD患者肺功能与气体交换参数,降低支气管舒张试验反应,促进症状与体征恢复,且安全性高。     

ACO患者血清Fbg、FeNO、IgE水平变化与肺功能相关性研究

目的探讨支气管哮喘-慢性阻塞性肺疾病重叠综合征(ACO)患者血清中纤维蛋白原(Fbg)、呼出气一氧化氮(FeNO)、免疫球蛋白E(IgE)的变化水平与肺功能的相关性。 方法选择2016年1月至2018年5月期间在我院接受治疗的支气管哮喘急性发作期患者56例,慢阻肺急性加重期患者51例,ACO急性加重期患者45例,同时选取50例健康者作为对照。检测受试对象的外周血嗜酸性粒细胞数量、Fbg和IgE水平、FeNO以及肺功能指标。采用Pearson相关性分析Fbg、FeNO、IgE与1 s用力呼气容积(FEV₁),FEV₁改善值,用力肺活量(FVC)的关系。绘制受试者工作特征(ROC)曲线,并计算Fbg、FeNO、IgE指标曲线下面积(AUC)。 结果①三组患者嗜酸性粒细胞数量和血浆IgE水平明显高于对照组(P<0.05);但是三组患者之间比较,未见统计学差异(P>0.05)。ACO患者血清Fbg水平高于哮喘组患者(P<0.05),FeNO检测值高于慢阻肺患者(P<0.05);②ACO患者FEV₁、FEV₁改善值和FVC值明显高于对照组和慢阻肺组受试者,但是FEV₁值高于哮喘组患者,而FEV₁改善值和FVC值低于哮喘组患者(P<0.05);③ACO患者血浆Fbg水平与FEV₁、FEV₁改善值和FVC值均呈负相关性(P<0.05),而FeNO值仅与FEV₁值呈负相关性(P<0.05)。而血浆IgE水平与FEV₁改善值呈正负关性(P<0.05);④经ROC曲线分析,Fbg、FeNO、IgE联合检测ROC曲线的AUC为0.892(95%CI：0.773-0.948),敏感性和特异性分别为89%和78%。 结论Fbg、FeNO和IgE与ACO患者肺功能指标密切相关,有助于临床鉴别ACO、支气管哮喘以及慢性阻塞性肺疾病。     

Is Combined Therapy of Sympathomimetics and Theophylline Indicated?

Bronchodilator effect and toxicity of theophylline 300 mg twice a day (R₁), salbutamol 4 mg tid (R₂), their combination in higher (200/4mg, R₃), and lower doses (100/2mg R₄), and placebo (calcium lactate 300 mg) tid (R₅) were compared in 25 patients with bronchial asthma in a randomized crossover trial. Statistically significant improvement in forced expiratory volume in one second (FEV₁) was observed in all the active treatment groups (R₁ to R₄) compared with placebo (R₅). The mean improvement in FEV₁ was 29.0%, 22.0%, 28.0%, 30.0%, and 0.73% in regimen R₁, R₂, R₃, R₄, and R₅, respectively day 1, and corresponding improvement was 30.0%, 24.0%, 29.0%, 34.0%, and 4.4% on completion of one week therapy. On intergroup statistical comparison, mean improvement in pulmonary function test values were statistically significant or highly significant in regimens R₁ to R₄, as compared with placebo. However, improvement between any two regimens was not statistically significant in any of the regimens (R₁-R₄). Almost all the regimens were tolerated well and no patient showed major adverse reactions or cardiotoxicity necessitating withdrawal of the drug. On the other hand, minor adverse reactions were common and the high dose combination (R₃) was found to have more adverse reactions than the low dose combination and either drug used alone.     

华盖散联合二陈汤治疗变异性支气管哮喘的临床分析

目的探讨华盖散联合二陈汤治疗咳嗽变异性哮喘的临床疗效。 方法以自2016年9月－2017年9月于我院呼吸科就诊并接受治疗的116例咳嗽变异性哮喘患者为研究对象,按随机数字表方式分为对照组(n＝58)和研究组(n＝58)。对照组患者给予西医治疗,研究组患者在对照组治疗的基础上同时予以华盖散联合二陈汤行中医治疗。比较患者治疗前后血清嗜酸性粒细胞计数、IgE、ECP含量水平变化,检测治疗前后患者FEV₁和PEF变异率,评估两组患者咳嗽变异性哮喘的疗效水平,观察患者治疗期间药物不良反应情况。 结果治疗前,两组患者血清嗜酸性粒细胞计数、IgE、ECP、FEV₁和PEF变异率差异均无统计学意义(t＝0.196,0.625,0.248,0.536,0.313;P＝0.703,0.371,0.652,0.451,0.672>0.05);治疗结束后,两组患者嗜酸性粒细胞计数、IgE、ECP和PEF变异率均较治疗前显著降低(t＝5.026,8.514,7.932,6.047;P＝0.000,0.000,0.000,0.000<0.05),FEV₁较治疗前显著增加(t＝7.251;P＝0.000<0.05),且研究组患者治疗后血清嗜酸性粒细胞计数、IgE和ECP含量水平均显著低于对照组患者水平,而FEV₁显著高于对照组患者水平(t＝2.916,4.153,2.896,2.854;P＝0.007,0.000,0.014,0.031<0.05);研究组患者咳嗽变异性哮喘治疗总体有效率(93.10%)显著高于对照组患者水平(79.31%)(χ²＝4.640,P＝0.031<0.05);治疗期间,研究组患者药物不良反应总体发生率(8.62%)与对照组患者水平(10.34%)差异不具有统计学意义(χ²＝0.425,P＝0.514>0.05)。 结论较单纯西医治疗,加用华盖散联合二陈汤可显著降低呼吸道炎症反应和变态反应程度,改善咳嗽变异性哮喘患者肺功能,提高咳嗽变异性哮喘疗效水平,且不增加药物不良反应,值得临床推广使用。     

Comparison of Mometasone Furoate Dry Powder Inhaler and Fluticasone Propionate Dry Powder Inhaler in Patients with Moderate to Severe Persistent Asthma Requiring High-Dose Inhaled Corticosteroid Therapy: Findings from a Noninferiority Trial

Background. Inhaled corticosteroids (ICSs) are one of the suggested first-line therapies for patients with persistent asthma of moderate severity. Methods: The efficacy and safety of mometasone furoate (MF) 400 μg twice daily (BID) and fluticasone propionate (FP) 500 μ g BID administered for 12 weeks via dry powder inhaler (DPI) were compared in a noninferiority trial, in adults with moderate-to-severe persistent asthma. The primary variable was the change from baseline in am peak expiratory flow rate (PEFR). pm PEFR, forced expiratory volume in 1 second (FEV₁), asthma symptoms, rescue medication use, response to therapy, exacerbation rates, and adverse events were also assessed. Results. The lower bound of 95% CIs for treatment differences in the primary variable ranged from 2.6% to 5.6% throughout the 12-week study and were within the prespecified noninferiority range. No significant between-group differences were observed in lung function, rescue medication use, response to therapy, exacerbation rates, or adverse events. At most of the weeks assessed, there were no between-group differences in asthma symptoms. Most adverse events were mild-to-moderate. Conclusion. MF-DPI 400 μ g BID was therapeutically equivalent to FP-DPI 500 μ g BID in patients with moderate-to-severe persistent asthma.     

Airway Effects of Monosodium Glutamate in Subjects with Chronic Stable Asthma

We studied the effect of oral monosodium glutamate (MSG) on airways function in 12 subjects with a history of chronic stable asthma in a double-blind, randomized, crossover protocol. Subjects ingested either 25 mg/kg of MSG or sodium chloride (equimolar to MSG) following a 6-hour fast. Spirometry [forced expiratory volume in 1 second (FEV₁) and forced vital capacity] was performed before administration of the test substances and for a minimum of 4 hours thereafter. At no time during the observation period was the mean change in FEV₁ more negative following MSG than following placebo. MSG is unlikely to be a contributing factor in bouts of broncho-spasm in subjects with asthma, and routine avoidance of MSG by individuals with asthma need not be advised.     

Dietary Intake of Soy Genistein is Associated with Lung Function in Patients with Asthma

To determine if micronutrient intake is associated with asthma severity, we administered the Block food frequency questionnaire to participants in a randomized clinical trial of the safety of influenza vaccine for asthmatics. The nutrition substudy included 1033 participants, aged 12-75. Intake of antioxidant vitamins, soy isoflavones, total fruits and vegetables, fats, and fiber was compared with asthma severity at baseline [forced expiratory volume in 1 second (FEV₁), peak expiratory flow rate (PEF), asthma symptoms] and the rate of asthma exacerbations during the 2 weeks following influenza vaccination. The only nutrient that had a consistent association with asthma severity was genistein, a soy isoflavone. None of the nutrients evaluated were related to asthma exacerbation rate when adjusted for known confounders. The FEV₁ in genistein consumers of at least 250 µg/1000 Kcal/day was 82.1% predicted, 79.9% predicted for those who consumed between 1 and 249 µg/1000 kcal, and 76.2% predicted in genistein nonconsumers (p = 0.006); the PEF was 82.7% predicted, 80.8% predicted, and 78.3% predicted, respectively (p = 0.009). There were no differences in the Asthma Symptom Utility Index (ASUI). We could not account for these results based on differences in demographics, body mass index, or consumption of other nutrients. Thus, increasing consumption of genistein is associated with better lung function in patients with asthma. Further studies are needed to determine whether dietary supplementation with genistein can reduce asthma severity.     

Pulmonary Function in a Hospital Population of Asthmatic Children

Traditionally, assessment of control of pediatric asthma has relied on symptoms reported by the child and his or her family, and on clinical examination at office visits. A survey of the pulmonary function of 100 clinically stable asthmatic children, recruited from the outpatient clinics of the Royal Children's Hospital, Melbourne, Australia for a clinical drug trial was performed. Correlation of baseline pulmonary function with symptom scores recorded at home and home monitoring of peak expiratory flow variability (PEFV) found that a third of these clinically stable asthmatic children had an abnormal FEV₁ and half had an abnormal FEF_25-75; however, there was no correlation between symptom scores and FEV₁ or PEFV. Objective measurements of pulmonary function are needed to ensure good asthma control. Home monitoring of peak expiratory flow can provide a valuable aid for the management of pediatric asthma.     

Mouthpiece Versus Facemask for Delivery of Nebulized Salbutamol in Exacerbated Childhood Asthma

We compared the bronchodilator response to salbutamol (albuterol) delivered by a compressed air nebulizer through a mouthpiece and via a facemask in 18 asthmatic children, to determine the most appropriate delivery method. Patients using a mouthpiece had significantly better mean percent increases in forced expiratory volume in 1 sec (FEV₁) and in forced vital capacity (FVC) than those using a facemask 30 min after inhalation (FEV₁: 56.4 ± 32.6 % vs. 28.9 ± 19.1%, FVC: 34.4 ± 26.4% vs. 7.5 ± 14.9%, respectively). Nebulized therapy plays an important role in the management of bronchial asthma in children and should be delivered by a mouthpiece whenever possible in cases of exacerbated asthma.     

Bronchial Asthma Showing Reduction in FEV1 after Inhalation of Qvar™

The administration of Qvar (a hydrofluoroalkane-134a beclomethasone dipropionate; HFA-BDP) is highly useful for the treatment of patients with asthma. However, we found in a case of bronchial asthma that replacing the prior inhaled corticosteroids with Qvar resulted in temporary dyspnea and reduction in forced expiratory volume in 1 second (FEV₁). Qvar contains beclomethasone dipropionate combined with absolute ethanol and an alternative to fluorocarbon. The patient had complicated alcohol-induced asthma. FEV₁ decreased markedly and immediately after Qvar inhalation. The Qvar placebo is free of beclomethasone but contains other ingredients (ethanol and fluorocarbon). FEV₁ did not decrease after the Qvar placebo, Aldecin inhalation, and Qvar inhalation orally treated with atropine before inhalation of Qvar™. It seems unlikely that the components of Qvar (except beclomethasone) are responsible for the reduction in FEV₁ observed immediately after inhalation of Qvar. These findings would be noteworthy when using Qvar for Japanese patients with asthma known to have a relatively high frequency of the complication of alcohol-induced asthma.     

Symptomatic Vascular Rings in Adulthood: An Uncommon Mimic of Asthma

Symptomatic thoracic vascular rings presenting in adulthood are thought to be rare. During a 3-year time period, we diagnosed four cases of symptomatic vascular rings, which had been treated unsuccessfully for suspected asthma. Spirometry was characterized by normal forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV₁), and FEV₁/FVC, decreased peak expiratory flow (PEF), and truncation of the expiratory flow volume loop. Chest radiographs revealed a right aortic arch in each case with computed tomography (CT) or magnetic resonance imaging (MRI) confirming the diagnosis of a vascular ring. The specific abnormalities consisted of right aortic arch with mirror branching of the main arteries and persistent ligamentum arteriosum; right aortic arch with diverticulum and a fibrous embryonic left arch; right aortic arch with aberrant left subclavian artery arising from a diverticulum of Kommerell; and a right aortic arch with persistent ligamentum arteriosum. Although they are uncommon, vascular rings first presenting in adulthood as a mimic of asthma are not rare. This diagnosis should be considered in adults when abnormal truncation of the flow-volume loop occurs or when radiographic aortic arch abnormalities are found.