Active Asthma Research Articles

Next stop for HDL: the lung

Next stop for <scp>HDL</scp>: the lung

A Meta-Analysis of Adverse Perinatal Outcomes in Women With Asthma

Asthma is a relatively common chronic medical condition among pregnant women. Although some studies have suggested that maternal asthma increases the risk of perinatal complications in both mothers and infants, the published data are conflicting. Thus, the aim of this meta-analysis was to investigate whether maternal asthma is associated with an increased risk of adverse perinatal outcomes and to determine the extent of these effects. Electronic databases were used to identify abstracts of studies published between 1975 and 2009 using the following search terms: (asthma or wheeze) and (pregnant or perinatal or obstetrics). All observational studies were either prospective or retrospective in design and reported at least 1 perinatal outcome of interest. Among women with and without asthma, the relative risk (RR) was compared for at least 1 perinatal outcome, and, when possible, stratified by active asthma management and no active asthma management. Of the 103 articles identified for possible inclusion, 40 involving a total of 1,637,180 women met the inclusion criteria, including data on birth weight, preterm labor, preterm birth, and preeclampsia. Several adverse perinatal outcomes were associated with maternal asthma: an increased risk of low birth weight (RR, 1.46; 95% confidence interval [CI], 1.22–1.75), small for gestational age (RR, 1.22; 95% CI, 1.14–1.31), preterm delivery (RR, 1.41; 95% CI, 1.22–1.61), and preeclampsia (RR, 1.54; 95% CI, 1.32–1.81); all P values were <0.0001 or <0.00001. However, with active management, the risk of preterm delivery and preterm labor was reduced to clinically and statistically nonsignificant levels (RR, 1.07; 95% CI, 0.91–1.26, and RR, 0.96; 95% CI, 0.73–1.26, respectively). These findings indicate that maternal asthma increases the risk in both infants and mothers of several perinatal complications, including those affecting the baby's size and timing of birth and preeclampsia. The data suggest that active asthma management to reduce the exacerbation rate has the potential to decrease the risk of perinatal complications.

Predictors of Asthma Self-Management Education among Children and Adults—2006–2007 Behavioral Risk Factor Surveillance System Asthma Call-back Survey

Background. Patient self-management, besides expert care, is necessary to improve health outcomes among persons with asthma. Our objective was to describe the characteristics of persons with asthma likely to receive asthma self-management education. Methods. The 2006 and 2007 Behavioral Risk Factor Surveillance System (BRFSS) Child and Adult Asthma Call-back Survey (ACBS) data were analyzed. Binary and multinomial response logistic regression models were used to examine the association between asthma self-management education and explanatory variables. Results. Of the 31,278 persons who ever had asthma, 3953 of the children (75.8%) and 19,723 of the adults (72.8%) were classified as having active asthma. For both children and adults, the three most commonly reported asthma education components were being taught how to use an inhaler (78.6% and 89.8%, respectively); being taught what to do during an asthma episode (86.3% and 74.6%); and to recognize early signs or symptoms of an asthma episode (82.0% and 64.4%). Children and adults who reported routine care visits, hospitalization, and asthma episodes in the past 12 months because of asthma were more likely to report several asthma education components and higher asthma education scores. Children aged 12–17 years were more likely to report having instruction in peak flow meter use (1.3; 1.1–1.6) and inhaler use (1.3; 1.2–1.4), whereas older adults (aged 54–64 years or 65+ years), adults who were not high school (HS) graduates, and smokers were less likely to report having asthma management education than the corresponding comparison groups. Conclusions. Having a routine care visit, being hospitalized, and having an asthma episode were significantly associated with reporting multiple asthma education components, whereas being an older adult, having less than a HS degree, and being a smoker were associated with reporting fewer asthma education components. Asthma control programs should continue to monitor asthma self-management education and promote asthma education to all persons with asthma, especially for older adults, persons with less education, and smokers.

Active and Uncontrolled Asthma Among Children Exposed to Air Stack Emissions of Sulphur Dioxide from Petroleum Refineries in Montreal, Quebec: A Cross-Sectional Study

Little attention has been devoted to the effects on children's respiratory health of exposure to sulphur dioxide (SO2) in ambient air from local industrial emissions. Most studies on the effects of SO(2) have assessed its impact as part of the regional ambient air pollutant mix. To examine the association between exposure to stack emissions of SO(2) from petroleum refineries located in Montreal's (Quebec) east-end industrial complex and the prevalence of active asthma and poor asthma control among children living nearby. The present cross-sectional study used data from a respiratory health survey of Montreal children six months to 12 years of age conducted in 2006. Of 7964 eligible households that completed the survey, 842 children between six months and 12 years of age lived in an area impacted by refinery emissions. Ambient SO(2) exposure levels were estimated using dispersion modelling. Log-binomial regression models were used to estimate crude and adjusted prevalence ratios (PRs) and 95% CIs for the association between yearly school and residential SO(2) exposure estimates and asthma outcomes. Adjustments were made for child's age, sex, parental history of atopy and tobacco smoke exposure at home. The adjusted PR for the association between active asthma and SO(2) levels was 1.14 (95% CI 0.94 to 1.39) per interquartile range increase in modelled annual SO(2). The effect on poor asthma control was greater (PR=1.39 per interquartile range increase in modelled SO(2) [95% CI 1.00 to 1.94]). Results of the present study suggest a relationship between exposure to refinery stack emissions of SO(2) and the prevalence of active and poor asthma control in children who live and attend school in proximity to refineries.

Anaphylaxis to Skin Prick Testing in a 29-Year-Old Woman

Introduction: Skin prick testing (SPT) is a common test to diagnose IgE sensitization and the rate of adverse reactions is very low. Case Presentation: 29-year-old woman with anaphylactic reaction to routine SPT with 11 allergens (aero and food). Discussion: Allergy profile included multiple food and inhalant allergies, polysensitization, prior episode of anaphylaxis to mushrooms, active eczema and active hay fever but not active asthma. Conclusion: Anaphylaxis to SPT, although a rare event, is unpredictable necessitating availability of appropriate personnel and adequate resuscitation facilities for all testing.

The course of asthma activity: A population study

Unlike most chronic diseases, which tend to progress over time, asthma is known to persist, possibly resolve, and/or present with any combination of remissions and relapses. As a result, its course has been difficult to characterize and its prognosis difficult to predict. To quantify the proportion of individuals with asthma who have active disease and, of those, the proportion who experience significant gaps in their asthma activity; and to determine factors associated with asthma activity. Universal population health administrative databases were used to identify all individuals with asthma living in Ontario, Canada, in 1993 and follow them for 15 years. Active asthma was indicated by 1 or more physician claims for asthma. Of 613,394 individuals with asthma in 1993, 504,851 (82.3%) had active disease in subsequent years. Of those who had complete follow-up, 74.6% experienced a gap of 2 or more years in their asthma activity. Previous asthma claims, older and younger age, and a codiagnosis of chronic obstructive pulmonary disease correlated with greater asthma activity. Over 15 years, most individuals with asthma in Ontario, Canada, had active disease that was interspersed by periods of inactivity when they did not require medical attention and were likely in remission. These analyses offer insight into the natural course of asthma activity that may help improve the ability to predict an individual's course of disease.

Bronchial hyperresponsiveness decreases through childhood

Limited knowledge exists about development of bronchial hyperresponsiveness (BHR) through adolescence. We aimed to assess changes in and risk factors for BHR in adolescence. From a Norwegian birth cohort 517 subjects underwent clinical examinations, structured interviews and methacholine challenges at age 10 and 16. BHR was divided into four categories: no BHR (cumulative methacholine dose required to reduce FEV(1) by 20% (PD(20)) >16 μmol), borderline BHR (PD(20) ≤16 and >8 μmol), mild to moderate BHR (PD(20) ≤8 and >1 μmol), and severe BHR (PD(20) ≤ 1 μmol). Logistic regression analysis was used to assess risk factors and possible confounders. The number of children with PD(20) ≤ 8 decreased from 172 (33%) to 79 (15%) from age 10-16 (p < 0.001). Most children (n = 295, 57%) remained in the same BHR (category) from age 10-16 (50% with no BHR), whereas the majority 182 (82%) of the 222 children who changed BHR category, had decreased severity at age 16. PD(20) ≤ 8 at age 10 was the major risk factor for PD(20) ≤ 8 6 years later (odds ratio 6.3), without significant confounding effect (>25% change) of gender, active rhinitis, active asthma, height, FEV(1)/FVC, or allergic sensitization. BHR decreased overall in severity through adolescence, was stable for the majority of children and only a minority (8%) had increased BHR from age 10 to 16. Mild to moderate and severe BHR at age 10 were major risk factors for PD(20) ≤ 8 at 16 years and not modified by asthma or body size.

Asthma and the Achievement Gap Among Urban Minority Youth

To outline the prevalence and disparities of asthma among school-aged urban minority youth, causal pathways through which poorly controlled asthma adversely affects academic achievement, and proven or promising approaches for schools to address these problems. Literature review. Asthma is the most common chronic disease affecting youth in the United States; almost 10 million youth under 18 (14%) have received a diagnosis and 6.8 million (9%) have active asthma. Average annual prevalence estimates were approximately 45% higher for Black versus White children (12.8% vs. 8.8%), as were average annual estimates of asthma attacks (8.4% vs. 5.8%). Urban minority youth have highly elevated prevalence of poorly controlled asthma as evidenced by overuse of emergency departments and under-use of efficacious medications. Poorly controlled asthma has functional consequences on cognition, connectedness with school, and absenteeism. Exemplary asthma programs include management and support systems, school health and mental health services, asthma education, healthy school environments, physical education and activity, and coordination of school, family, and community efforts. Asthma and, more importantly, poorly controlled asthma are highly and disproportionately prevalent among school-aged urban minority youth, has a negative impact on academic achievement through its effects on cognition, school connectedness, and absenteeism, and effective practices are available for schools to address this problem. To reduce the adverse effects of poorly controlled asthma on learning, a multifaceted approach to asthma control and prevention in which schools can and must play a central role is essential.

INTERACTIONS BETWEEN TRAFFIC AIR POLLUTION AND GLUTATHIONE S-TRANSFERASE GENES ON CHILDHOOD ASTHMA

Background and aims: Ambient traffic-related air pollutants, such as nitrogen dioxide (NO2), have shown adverse effects on respiratory health in children. However, few studies showed the interactive associations between traffic air pollution and genetic polymorphisms on childhood asthma. The aim of this study is to evaluate the role of glutathione S-transferase (GST) genetic polymorphisms potentially modifying the association between NO2 and asthma in Taiwanese children. Methods: We investigated 3714 seven-grade schoolchildren in Taiwan Children Health Study from 14 Taiwanese communities. Children’s exposure and disease status were measured from questionnaire by parents. Multiple logistic regression models were fitted to estimate the effects of NO2 exposures and GSTs polymorphisms on the prevalence of asthma and wheeze. Results: Compared with children in low-NO2 communities, those in high-NO2 communities had significantly increased risks of asthma (OR=1.65, 95% CI=1.09~2.50), late-onset asthma (OR=2.26, 95% CI=1.11~4.62), active asthma (OR=1.85, 95% CI=1.03~3.34), asthma under medication (OR=2.65, 95% CI=1.27~5.52) and wheeze (OR=1.54, 95% CI=1.10~2.16) among GSTP1 Ile/Val or Val/Val genotypes. Significant interactions were found between NO2 level and GSTP1 on asthma, late-onset asthma, asthma under medication and wheeze (p for interaction &lt; 0.05). Conclusions: Children under high traffic air pollution exposure are more susceptible to asthma, especially among those with GSTP1 Val allele.

Cord blood 25-hydroxyvitamin D levels are associated with aeroallergen sensitization in children from Tucson, Arizona

The association between vitamin D status at birth and childhood allergic outcomes is uncertain. The desert climate of Tucson offers a unique setting for studying the health effects of higher exposure to vitamin D. To assess the relationship between cord blood 25-hydroxyvitamin D (25[OH]D) levels and allergic outcomes through age 5 years. Cord blood 25(OH)D levels were measured in 219 participants in the Tucson Infant Immune Study, a population-based birth cohort. Plasma total IgE and specific IgE levels to 6 aeroallergens were measured at 1, 2, 3, and 5 years. Skin prick test (SPT) positivity (wheal diameter ≥ 3 mm) and physician-diagnosed active allergic rhinitis and asthma were assessed at age 5 years. Longitudinal models were used to assess the relationship between 25(OH)D and IgE levels. Logistic regression models were used to assess the relationship of 25(OH)D level with SPT positivity, allergic rhinitis, and asthma. The median cord blood 25(OH)D level was 64 nmol/L (interquartile range, 49-81 nmol/L). Relative to the reference group (50-74.9 nmol/L), both low (<50 nmol/L) and high (≥ 100 nmol/L) levels were associated with increased total IgE (coefficient = 0.27, P = .006 and coefficient = 0.27, P = .04, respectively) and detectable inhalant allergen-specific IgE (odds ratio = 2.4, P = .03 and odds ratio = 4.0, P = .01, respectively) through age 5 years. High 25(OH)D levels were also associated with increased SPT positivity (odds ratio = 4.0, P = .02). By contrast, the 25(OH)D level was not significantly associated with allergic rhinitis or asthma. Both low and high levels of cord blood 25(OH)D were associated with increased aeroallergen sensitization. The association between vitamin D status and actual allergic diseases merits further study.

Predicting the Long-Term Course of Asthma in Wheezing Infants Is Still a Challenge

Background. In recurrent wheezing infants, it is important to identify those likely to remain asthmatic in order to propose appropriate long-term management. Objective. To establish predictive factors for persistent asthma at adolescence in a population of recurrent wheezing infants. Methods. Retrospective study of 227 infants. Inclusion criteria were age under 36 months, a history of at least three wheezing episodes assessed via a doctor-led ISAAC questionnaire and a standardized allergy testing programme. At 13 years, active asthma was assessed by questionnaire. Results. Risk factors for asthma persisting into adolescence were allergic sensitization to multiple airborne allergens (OR 4.6, CI-95% (1.9–11.2) P = 0.001), initial atopic dermatitis (OR 3.4, CI-95% (1.9–6.3) P < 0.001), severe recurrent wheezing (OR 2.3, CI-95% (1.3–4.2) P = 0.007), and hypereosinophilia ≥470/mm3 (OR 2.2, CI-95% (1.07–4.7) P = 0.033). Conclusion. While it is still difficult to predict the long-term course of asthma, atopy remains the major risk factor for persistent asthma.

A meta-analysis of adverse perinatal outcomes in women with asthma

Asthma is a common condition during pregnancy and may be associated with adverse perinatal outcomes. This meta-analysis sought to establish if maternal asthma is associated with an increased risk of adverse perinatal outcomes, and to determine the size of these effects. Electronic databases were searched for the following terms: (asthma or wheeze) and (pregnan* or perinat* or obstet*). Cohort studies published between 1975 and March 2009 were considered for inclusion. Studies were included if they reported at least one perinatal outcome in pregnant women with and without asthma. A total of 103 articles were identified, and of these 40 publications involving 1,637,180 subjects were included. Meta-analysis was conducted with subgroup analyses by study design and active asthma management. Maternal asthma was associated with an increased risk of low birthweight (RR 1.46, 95% CI 1.22-1.75), small for gestational age (RR 1.22, 95% CI 1.14-1.31), preterm delivery (RR 1.41, 95% CI 1.22-1.61) and pre-eclampsia (RR 1.54, 95% CI 1.32-1.81). The relative risk of preterm delivery and preterm labour were reduced to non-significant levels by active asthma management (RR 1.07, 95% CI 0.91-1.26 for preterm delivery; RR 0.96, 95% CI 0.73-1.26 for preterm labour). Pregnant women with asthma are at increased risk of perinatal complications, including pre-eclampsia and outcomes that affect the baby's size and timing of birth. Active asthma management with a view to reducing the exacerbation rate may be clinically useful in reducing the risk of perinatal complications, particularly preterm delivery.

Adaptive cytokine production in early life differentially predicts total IgE levels and asthma through age 5 years

Although it has been postulated that allergic disease is associated with a predominance of T(H)2 cells, whether IgE levels and asthma might differ in their relation to early-life cytokine production is not known. We sought to assess the relationship between first-year adaptive immune cytokine production with asthma and total IgE levels through age 5 years in a nonselected birth cohort. Mitogen (concanavalin A/phorbol 12-myristate 13-acetate)-stimulated IL-4, IL-5, IL-13, and IFN-γ levels were measured in supernatants from cord blood mononuclear cells and PBMCs at birth, 3 months, and 12 months. Total serum IgE levels and physician-diagnosed active asthma were assessed at 1, 2, 3, and 5 years. Longitudinal models that adjust for both T(H)1 and T(H)2 cytokine production were used to determine relations of outcomes. Relations of cytokines to total IgE levels and asthma were strikingly different. Total IgE levels through age 5 years were positively associated with 12-month IL-4 (P< .001), IL-5 (P< .001), and IL-13 (P= .02) levels when adjusted for IFN-γ levels and inversely associated with 12-month IFN-γ levels after IL-4 adjustment (P= .01). Active asthma through age 5 years was positively associated with 3-month IL-13 levels adjusted forIFN-γ (odds ratio, 2.6; P< .001) and inversely associated with 3-month IFN-γ levels adjusted for IL-13 (odds ratio, 0.5; P= .001). These relations were strongest for nonatopic asthma. Total IgE levels and active asthma through age 5 years are associated with adaptive cytokine production in early life, although relations vary temporally and with regard to the relative importance of individual cytokines.

Factors Associated with Asthma Control among Adults in Five New England States, 2006–2007

Background. Despite the National Asthma Education and Prevention Program (NAEPP) guidelines that specify the goals of asthma control and management strategies, the number of patients with uncontrolled asthma remains high, and factors associated with uncontrolled asthma are unknown. Objective. The aim was to examine the relationship between asthma control and socio-demographic characteristics, health-care access and use, asthma education, and medication use among adults with active asthma residing in New England. Methods. Data from the 2006–2007 Behavior Risk Factor Surveillance System Adult Asthma Call-Back Survey were analyzed using multinomial logistic regression. Asthma control was categorized as “well controlled,” “not well controlled,” or “very poorly controlled” according to the NAEPP guidelines. Results. Of the respondents (n = 3079), 30% met the criteria for well-controlled asthma, 46% for not well-controlled asthma, and 24% for very poorly controlled asthma. Being of Hispanic ethnicity (odds ratio [OR] = 4.0; 95% confidence interval [CI] = 1.2–13.7), unemployed or unable to work (OR = 17.9; 95% CI = 6.0–53.4), high school educated or less (OR = 2.8; 95% CI = 1.6–4.7), current smokers (OR = 2.5; 95% CI = 1.3–5.1), or being unable to see a doctor or specialist for asthma care or unable to buy medication for asthma because of cost (OR = 7.6; 95% CI = 3.4–17.1) were associated with very poorly controlled asthma. In addition, having Coronary Obstructive Pulmonary Disease (COPD) (OR = 2.6; 95% CI = 1.5–4.5), two or more routine checkups for asthma (OR = 4.5; 95% CI = 2.3–8.9), or an emergency department visit, urgent care facility visit, and hospitalization in the past year (OR = 3.9; 95% CI = 2.1–7.3) were also associated with having very poorly controlled asthma. Using controller medication in the past year (OR = 2.6; 95% CI = 1.6–4.2) and taking a course on how to manage asthma (OR = 3.0; 95% CI = 1.2–7.8) were significantly associated with poor asthma control. Conclusion. The high prevalence (70%) of not well-controlled asthma and poorly controlled asthma in this study emphasizes the need to identify factors associated with poor asthma control for development of targeted intervention. A health policy of increasing asthma education, health-care access, and smoking cessation may be effective and result in better asthma control and management.

Obesity and asthma

In this issue of The Journal, the association between obesity and asthma in children has been investigated in a study of over 1800 children in the Fragile Families and Wellbeing Study by Suglia et al from Boston University and Albert Einstein College of Medicine. The results showed that 10% of children had active asthma, 19% were overweight, and 17% were obese. Obese children had twice the odds of having asthma compared with children of normal body weight. However, in stratified analyses, overweight boys, but not overweight girls, had increased odds of asthma. Both obese boys and girls had increased odds of asthma compared with boys and girls of normal body weight. In the analysis, it was found that the relationship was not attributable to shared social and environmental factors. The findings in this study and question of, “Are we any closer to understanding the relationship between childhood obesity and asthma?,” is addressed in an editorial by Donna Halloran, which discusses the new information in this study and provides suggestions for future research directions. Article page 14▶ Editorial page 3▶ Asthma and Obesity in Three-Year-Old Urban Children: Role of Sex and Home EnvironmentThe Journal of PediatricsVol. 159Issue 1PreviewTo examine whether the relationship between obesity and asthma in young girls and boys can be explained by social and physical characteristics of the home environment. Full-Text PDF Home Environment, Asthma, and Obesity: How Are They Related?The Journal of PediatricsVol. 159Issue 1PreviewNational data indicate that almost 12% of US children are obese.1 Although some argue that this obesity epidemic is attributable to genetic factors,2 others believe that the rapid change in rates of childhood obesity are related to changes in and characteristics of the environment (whether home, school, or neighborhood).3,4 Given the rapid progression of this epidemic, interventions to address these issues are ongoing.5-7 Full-Text PDF

Discriminative properties of two predictive indices for asthma diagnosis in a sample of preschoolers with recurrent wheezing

It is important to predict if preschool children with recurrent wheezing will suffer from asthma in future years. To aid in this early identification, a number of asthma predictive scores have been reported, such as the asthma predictive index (API) and the PIAMA risk score. However, to the best of our knowledge, their predictive properties have not been evaluated in any lower- to middle-income country. A prospective cohort study was carried out including preschoolers aged 1-3 years with recurrent wheezing who came to our Pediatric Pulmonary Unit in Bogota, Colombia. We collected the information required to complete the API index and the PIAMA risk score. At 5-6 years of age, the patients were contacted in order to determine if they were suffering from active asthma. We calculated the sensitivity, specificity, predictive values, and likelihood ratios (LR) of the API and PIAMA risk scores for the presence of active asthma at 5-6 years old. The mean age at recruitment of the 130 included patients was 27.2 ± 5.9 months. The loose API yielded a sensitivity of 71.4% (95% CI: 50.0-86.2), specificity of 33.3% (95% CI 23.5-44.8), and positive predictive value of 23.8% (95% CI: 15.0-35.6). The stringent API yielded a sensitivity of 42.9% (95% CI: 24.5-63.5), specificity of 79.2% (95% CI 68.4-86.9), positive predictive value of 37.5% (95% CI: 21.2-57.3), and positive LR of 2.06. The PIAMA risk score yielded a sensitivity of 54.5% (95% CI: 42.6-66.0), specificity of 78.9 (95% CI: 66.7-87.5), positive predictive value of 75.0 (95% CI: 61.2-85.1), and positive LR of 2.59. Our results suggest that both indices can be used to predict asthma in preschoolers with recurrent wheezing in the context of a referral hospital.

Prescribing of β-adrenoceptor antagonists in asthma: an observational study

Backgroundβ-Antagonists have recently been proposed for the treatment of chronic asthma; however, concerns regarding risk of acute bronchoconstriction in clinical trials remain.ObjectiveTo determine the frequency of oral β-blocker prescribing in...

Asthma and Obesity in Three-Year-Old Urban Children: Role of Sex and Home Environment

To examine whether the relationship between obesity and asthma in young girls and boys can be explained by social and physical characteristics of the home environment. We examined the relationship between asthma and obesity in children in the Fragile Families and Child Wellbeing Study (n=1815). Asthma was determined through maternal report of asthma diagnosis by a doctor (active in past 12 months). Weight and height of child was measured during an in-home visit. Data on home social (maternal depression, intimate partner violence) and physical environmental factors (housing quality, tobacco exposure) were collected via questionnaire. Ten percent of children had active asthma, 19% of children were overweight, and 17% of children were obese. In fully adjusted models, obese children had twice the odds of having asthma (OR, 2.3; 95% CI, 1.5-3.3) compared with children of normal body weight. In stratified analyses, overweight boys, but not overweight girls, had increased of odds of asthma. Obese boys and girls had increased odds of asthma compared with boys and girls of normal body weight. The relationship between asthma and obesity is present in boys and girls as young as 3 years of age; a relationship between being overweight and asthma is only present among boys. This relationship is not attributable to shared social and environmental factors of the children's home.

Tumour necrosis factor G-308A polymorphism modifies the effect of home dampness on childhood asthma

ObjectivesEnvironmental exposure at home, such as dampness, has been shown to have adverse effects on respiratory health. However, few studies explored the association between home dampness and genetic polymorphisms on...

Persisting Remodeling and Less Airway Wall Eosinophil Activation in Complete Remission of Asthma

Individuals with asthma may outgrow symptoms despite not using treatment, whereas others reach complete remission (CoR) with absence of airway obstruction and bronchial hyperresponsiveness. It is uncertain whether this associates with remission of all inflammatory and remodeling asthma features. To compare the pathologic phenotype of individuals with asthma with CoR and clinical remission (ClinR) and those with active asthma, with and without the use of inhaled corticosteroids (ICS). We investigated 165 individuals known with active asthma, on reexamination having CoR (n = 18), ClinR (n = 44), and current asthma (CuA, n = 103, 64 with and 39 without ICS). MEASUREMENTS MAIN RESULTS: Inflammatory cells were measured in blood, induced sputum, and bronchial biopsies; histamine and ECP in sputum; and eosinophilic peroxidase (EPX) immunopositivity and remodeling (epithelial changes, E-cadherin expression, basement membrane [BM] thickening, collagen deposition) in bronchial biopsies. Median (range) blood eosinophils from CoR were significantly lower than those from CuA (0.10 [0.04-0.24] vs. 0.18 [0.02-1.16] × 10⁹/L). Bronchial EPX immunopositivity was lower in CoR than in both ClinR and CuA (67 [0.5-462] vs. 95 [8-5329] and 172 [6-5313] pixels). Other inflammatory findings were comparable. BM thickness was lowest in CuA, caused by lower BM thickness in those using ICS (CoR, 6.3 [4.7-8.4]; ClinR, 6.5 [3.8-11.7]; CuA, 5.7 [2.8-12.6]; and ICS using CuA, 5.3 [2.8-8.2] μm). CoR is still accompanied by airway abnormalities because BM thickness is similar in individuals with asthma with CoR, ClinR, and CuA without ICS. Airway eosinophilic activation best differentiates these three groups, signifying their importance in the clinical expression and severity of bronchial hyperresponsiveness in asthma.