1. Eosinophilic and Noneosinophilic Asthma: An Expert Consensus Framework to Characterize Phenotypes in a Global Real-Life Severe Asthma Cohort.
- Author
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Heaney, LG, Perez de Llano, L, Al-Ahmad, M, Backer, V, Busby, J, Canonica, GW, Christoff, GC, Cosio, BG, FitzGerald, JM, Heffler, E, Iwanaga, T, Jackson, DJ, Menzies-Gow, AN, Papadopoulos, NG, Papaioannou, AI, Pfeffer, PE, Popov, TA, Porsbjerg, CM, Rhee, CK, Sadatsafavi, M, Tohda, Y, Wang, E, Wechsler, ME, Alacqua, M, Altraja, A, Bjermer, L, Björnsdóttir, US, Bourdin, A, Brusselle, GG, Buhl, R, Costello, RW, Hew, M, Koh, MS, Lehmann, S, Lehtimäki, L, Peters, M, Taillé, C, Taube, C, Tran, TN, Zangrilli, J, Bulathsinhala, L, Carter, VA, Chaudhry, I, Eleangovan, N, Hosseini, N, Kerkhof, M, Murray, RB, Price, CA, Price, DB, Heaney, LG, Perez de Llano, L, Al-Ahmad, M, Backer, V, Busby, J, Canonica, GW, Christoff, GC, Cosio, BG, FitzGerald, JM, Heffler, E, Iwanaga, T, Jackson, DJ, Menzies-Gow, AN, Papadopoulos, NG, Papaioannou, AI, Pfeffer, PE, Popov, TA, Porsbjerg, CM, Rhee, CK, Sadatsafavi, M, Tohda, Y, Wang, E, Wechsler, ME, Alacqua, M, Altraja, A, Bjermer, L, Björnsdóttir, US, Bourdin, A, Brusselle, GG, Buhl, R, Costello, RW, Hew, M, Koh, MS, Lehmann, S, Lehtimäki, L, Peters, M, Taillé, C, Taube, C, Tran, TN, Zangrilli, J, Bulathsinhala, L, Carter, VA, Chaudhry, I, Eleangovan, N, Hosseini, N, Kerkhof, M, Murray, RB, Price, CA, and Price, DB
- Abstract
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 FEV1, 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)
- Published
- 2021