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Eosinophilic and Noneosinophilic Asthma : An Expert Consensus Framework to Characterize Phenotypes in a Global Real-Life Severe Asthma Cohort

Heaney, Liam G. ; Perez de Llano, Luis ; Al-Ahmad, Mona ; Backer, Vibeke ; Busby, John ; Canonica, Giorgio Walter ; Christoff, George C. ; Cosio, Borja G. ; FitzGerald, J. Mark and Heffler, Enrico , et al. (2021) In Chest 160(3). p.814-830
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... (More)

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), 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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Asia, Europe, International Severe Asthma Registry, Middle East, North America
in
Chest
volume
160
issue
3
pages
17 pages
publisher
American College of Chest Physicians
external identifiers
  • scopus:85111240890
  • pmid:33887242
ISSN
0012-3692
DOI
10.1016/j.chest.2021.04.013
language
English
LU publication?
yes
id
c6493898-632f-4ecb-97c3-0193c0977fb6
date added to LUP
2021-12-22 08:43:33
date last changed
2024-03-18 12:32:41
@article{c6493898-632f-4ecb-97c3-0193c0977fb6,
  abstract     = {{<p>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 &lt; .001) and worse lung function (postbronchodilator % predicted FEV<sub>1</sub>, 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.</p>}},
  author       = {{Heaney, Liam G. and Perez de Llano, Luis and Al-Ahmad, Mona and Backer, Vibeke and Busby, John and Canonica, Giorgio Walter and Christoff, George C. and Cosio, Borja G. and FitzGerald, J. Mark and Heffler, Enrico and Iwanaga, Takashi and Jackson, David J. and Menzies-Gow, Andrew N. and Papadopoulos, Nikolaos G. and Papaioannou, Andriana I. and Pfeffer, Paul E. and Popov, Todor A. and Porsbjerg, Celeste M. and Rhee, Chin Kook and Sadatsafavi, Mohsen and Tohda, Yuji and Wang, Eileen and Wechsler, Michael E. and Alacqua, Marianna and Altraja, Alan and Bjermer, Leif and Björnsdóttir, Unnur S. and Bourdin, Arnaud and Brusselle, Guy G. and Buhl, Roland and Costello, Richard W. and Hew, Mark and Koh, Mariko Siyue and Lehmann, Sverre and Lehtimäki, Lauri and Peters, Matthew and Taillé, Camille and Taube, Christian and Tran, Trung N. and Zangrilli, James and Bulathsinhala, Lakmini and Carter, Victoria A. and Chaudhry, Isha and Eleangovan, Neva and Hosseini, Naeimeh and Kerkhof, Marjan and Murray, Ruth B. and Price, Chris A. and Price, David B.}},
  issn         = {{0012-3692}},
  keywords     = {{Asia; Europe; International Severe Asthma Registry; Middle East; North America}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{814--830}},
  publisher    = {{American College of Chest Physicians}},
  series       = {{Chest}},
  title        = {{Eosinophilic and Noneosinophilic Asthma : An Expert Consensus Framework to Characterize Phenotypes in a Global Real-Life Severe Asthma Cohort}},
  url          = {{http://dx.doi.org/10.1016/j.chest.2021.04.013}},
  doi          = {{10.1016/j.chest.2021.04.013}},
  volume       = {{160}},
  year         = {{2021}},
}