TY - JOUR
T1 - Eosinophilic and non-eosinophilic asthma
T2 - an expert consensus framework to characterize phenotypes in a global real-life severe asthma cohort
AU - Heaney, Liam G
AU - Perez de Llano, Luis
AU - Al-Ahmad, Mona
AU - Backer, Vibeke
AU - Busby, John
AU - Canonica, Giorgio Walter
AU - Christoff, George C
AU - Cosio, Borja G
AU - FitzGerald, J Mark
AU - Heffler, Enrico
AU - Iwanaga, Takashi
AU - Jackson, David J
AU - Menzies-Gow, Andrew N
AU - Papadopoulos, Nikolaos G
AU - Papaioannou, Andriana I
AU - Pfeffer, Paul E
AU - Popov, Todor A
AU - Porsbjerg, Celeste M
AU - Rhee, Chin Kook
AU - Sadatsafavi, Mohsen
AU - Tohda, Yuji
AU - Wang, Eileen
AU - Wechsler, Michael E
AU - Alacqua, Marianna
AU - Altraja, Alan
AU - Bjermer, Leif
AU - Björnsdóttir, Unnur S
AU - Bourdin, Arnaud
AU - Brusselle, Guy G
AU - Buhl, Roland
AU - Costello, Richard W
AU - Hew, Mark
AU - Siyue, Mariko Koh
AU - Lehmann, Sverre
AU - Lehtimäki, Lauri
AU - Peters, Matthew
AU - Taillé, Camille
AU - Taube, Christian
AU - Tran, Trung N
AU - Zangrilli, James
AU - Bulathsinhala, Lakmini
AU - Carter, Victoria A
AU - Chaudhry, Isha
AU - Eleangovan, Neva
AU - Hosseini, Naeimeh
AU - Kerkhof, Marjan
AU - Murray, Ruth B
AU - Price, Chris A
AU - Price, David B
N1 - Copyright © 2021. Published by Elsevier Inc.
PY - 2021/9
Y1 - 2021/9
N2 - BACKGROUND: Phenotypic characteristics of patients with eosinophilic and noneosinophilic asthma are not well characterized in global, real-life severe asthma cohorts.RESEARCH QUESTION: What is the prevalence of eosinophilic and noneosinophilic phenotypes in the population with severe asthma, and can these phenotypes be differentiated by clinical and biomarker variables?STUDY DESIGN AND METHODS: This was an historical registry study. Adult patients with severe asthma and available blood eosinophil count (BEC) from 11 countries enrolled in the International Severe Asthma Registry (January 1, 2015-September 30, 2019) were categorized according to likelihood of eosinophilic phenotype using a predefined gradient eosinophilic algorithm based on highest BEC, long-term oral corticosteroid use, elevated fractional exhaled nitric oxide, nasal polyps, and adult-onset asthma. Demographic and clinical characteristics were defined at baseline (ie, 1 year before or closest to date of BEC).RESULTS: One thousand seven hundred sixteen patients with prospective data were included; 83.8% were identified as most likely (grade 3), 8.3% were identified as likely (grade 2), and 6.3% identified as least likely (grade 1) to have an eosinophilic phenotype, and 1.6% of patients showed a noneosinophilic phenotype (grade 0). Eosinophilic phenotype patients (ie, grades 2 or 3) showed later asthma onset (29.1 years vs 6.7 years; P < .001) and worse lung function (postbronchodilator % predicted FEV
1, 76.1% vs 89.3%; P = .027) than those with a noneosinophilic phenotype. Patients with noneosinophilic phenotypes were more likely to be women (81.5% vs 62.9%; P = .047), to have eczema (20.8% vs 8.5%; P = .003), and to use anti-IgE (32.1% vs 13.4%; P = .004) and leukotriene receptor antagonists (50.0% vs 28.0%; P = .011) add-on therapy.
INTERPRETATION: According to this multicomponent, consensus-driven, and evidence-based eosinophil gradient algorithm (using variables readily accessible in real life), the severe asthma eosinophilic phenotype was more prevalent than previously identified and was phenotypically distinct. This pragmatic gradient algorithm uses variables readily accessible in primary and specialist care, addressing inherent issues of phenotype heterogeneity and phenotype instability. Identification of treatable traits across phenotypes should improve therapeutic precision.
AB - BACKGROUND: Phenotypic characteristics of patients with eosinophilic and noneosinophilic asthma are not well characterized in global, real-life severe asthma cohorts.RESEARCH QUESTION: What is the prevalence of eosinophilic and noneosinophilic phenotypes in the population with severe asthma, and can these phenotypes be differentiated by clinical and biomarker variables?STUDY DESIGN AND METHODS: This was an historical registry study. Adult patients with severe asthma and available blood eosinophil count (BEC) from 11 countries enrolled in the International Severe Asthma Registry (January 1, 2015-September 30, 2019) were categorized according to likelihood of eosinophilic phenotype using a predefined gradient eosinophilic algorithm based on highest BEC, long-term oral corticosteroid use, elevated fractional exhaled nitric oxide, nasal polyps, and adult-onset asthma. Demographic and clinical characteristics were defined at baseline (ie, 1 year before or closest to date of BEC).RESULTS: One thousand seven hundred sixteen patients with prospective data were included; 83.8% were identified as most likely (grade 3), 8.3% were identified as likely (grade 2), and 6.3% identified as least likely (grade 1) to have an eosinophilic phenotype, and 1.6% of patients showed a noneosinophilic phenotype (grade 0). Eosinophilic phenotype patients (ie, grades 2 or 3) showed later asthma onset (29.1 years vs 6.7 years; P < .001) and worse lung function (postbronchodilator % predicted FEV
1, 76.1% vs 89.3%; P = .027) than those with a noneosinophilic phenotype. Patients with noneosinophilic phenotypes were more likely to be women (81.5% vs 62.9%; P = .047), to have eczema (20.8% vs 8.5%; P = .003), and to use anti-IgE (32.1% vs 13.4%; P = .004) and leukotriene receptor antagonists (50.0% vs 28.0%; P = .011) add-on therapy.
INTERPRETATION: According to this multicomponent, consensus-driven, and evidence-based eosinophil gradient algorithm (using variables readily accessible in real life), the severe asthma eosinophilic phenotype was more prevalent than previously identified and was phenotypically distinct. This pragmatic gradient algorithm uses variables readily accessible in primary and specialist care, addressing inherent issues of phenotype heterogeneity and phenotype instability. Identification of treatable traits across phenotypes should improve therapeutic precision.
KW - Asia
KW - Europe
KW - International Severe Asthma Registry
KW - Middle East
KW - North America
UR - http://www.scopus.com/inward/record.url?scp=85111240890&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2021.04.013
DO - 10.1016/j.chest.2021.04.013
M3 - Journal article
C2 - 33887242
SN - 0012-3692
VL - 160
SP - 814
EP - 830
JO - Chest
JF - Chest
IS - 3
ER -