Permanent respiratory impairment and upper airway symptoms despite clinical improvement in patients with reactive airways dysfunction syndrome

We previously reported clinical findings for 19 patients who developed symp tomatic airways hyperactivity following an acute exposure to an inhaled irr itant and who were given the diagnosis of reactive airways dysfunction synd rome (RADS). We now report on nine of these patients who have been followed for a mean of 9 years, allowing assessment of function, symptoms, and como rbidity beyond the early phase of acute airway injury and inflammation. Non e of the patients have resolved their airway hyper-responsiveness and sympt oms completely, although only in one subject, who had a premorbid history o f asthma, has the condition progressed. A common feature has been sinusitis and other upper-airway symptoms. We conclude that in this group of patient s, RADS presented in a consistent pattern regardless of the cause of airway injury, resolved only partially, even in subjects without a premorbid hist ory of respiratory disease, and was associated with significant secondary m orbidity, especially affecting the upper airway. This pattern was evident r egardless of smoking status or age at time of exposure. We conclude that fo r these subjects, RADS was a distinct entity with a consistent natural hist ory that conferred permanent impairment, but did generally improve somewhat over time. (C) 2001 Elsevier Science B.V. All rights reserved.