Severe adult-onset asthma: A distinct phenotype
| Autor: | Jantina C. de Groot, Anneke ten Brinke, Selma B. de Nijs, René Lutter, Peter J. Sterk, Elisabeth H. Bel, Marijke Amelink, Aeilko H. Zwinderman |
|---|---|
| Přispěvatelé: | Other departments, Graduate School, AII - Amsterdam institute for Infection and Immunity, Pulmonology, Experimental Immunology, APH - Amsterdam Public Health, Epidemiology and Data Science |
| Jazyk: | angličtina |
| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Exacerbation Neutrophils Immunology Nitric Oxide Severity of Illness Index Leukocyte Count Young Adult Nasal Polyps Internal medicine Eosinophilia Nose Diseases Severity of illness medicine Humans Immunology and Allergy Outpatient clinic Age of Onset Aged Asthma Inflammation business.industry Odds ratio Middle Aged Eosinophil medicine.disease respiratory tract diseases Eosinophils Phenotype medicine.anatomical_structure Exhalation Exhaled nitric oxide Sputum Female medicine.symptom business |
| Zdroj: | Journal of allergy and clinical immunology, 132(2), 336-341. Mosby Inc. |
| ISSN: | 0091-6749 |
| Popis: | Background Some patients with adult-onset asthma have severe disease, whereas others have mild transient disease. It is currently unknown whether patients with severe adult-onset asthma represent a distinct clinical phenotype. Objective We sought to investigate whether disease severity in patients with adult-onset asthma is associated with specific phenotypic characteristics. Methods One hundred seventy-six patients with adult-onset asthma were recruited from 1 academic and 3 nonacademic outpatient clinics. Severe refractory asthma was defined according to international Innovative Medicines Initiative criteria, and mild-to-moderate persistent asthma was defined according to Global Initiative for Asthma criteria. Patients were characterized with respect to clinical, functional, and inflammatory parameters. Unpaired t tests and χ 2 tests were used for group comparisons; both univariate and multivariate logistic regression were used to determine factors associated with disease severity. Results Apart from the expected high symptom scores, poor quality of life, need for high-intensity treatment, low lung function, and high exacerbation rate, patients with severe adult-onset asthma were more often nonatopic (52% vs 34%, P = .02) and had more nasal symptoms and nasal polyposis (54% vs 27%, P ≤ .001), higher exhaled nitric oxide levels (38 vs 27 ppb, P = .02) and blood neutrophil counts (5.3 vs 4.0 10 9 /L, P ≤ .001) and sputum eosinophilia (11.8% vs 0.8%, P ≤ .001). Multiple logistic regression analysis showed that increased blood neutrophil (odds ratio, 10.9; P = .002) and sputum eosinophil (odds ratio, 1.5; P = .005) counts were independently associated with severe adult-onset disease. Conclusion The majority of patients with severe adult-onset asthma are nonatopic and have persistent eosinophilic airway inflammation. This suggests that severe adult-onset asthma has a distinct underlying mechanism compared with milder disease. |
| Databáze: | OpenAIRE |
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