Treatment responsiveness of phenotypes of symptomatic airways obstruction in adults - 06/03/15
for the
New Zealand Respiratory Health Survey Study Group
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Abstract |
Background |
Asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous disorders encompassing different phenotypes of airflow obstruction, which might differ in their response to treatment.
Objective |
The aim of this study was to determine distinct phenotypes comprising the syndromes of asthma and COPD and the treatment responsiveness of these phenotypes to inhaled β-agonist, antimuscarinic, and corticosteroid therapy.
Methods |
We undertook a cross-sectional study with 3 phases. In phase 1, 1,264 participants aged 18 to 75 years with self-reported current wheeze and breathlessness were identified from a random population sample of 16,459. In phase 2, 451 participants attended for detailed assessment, including responsiveness to inhaled salbutamol and ipratropium bromide. In phase 3, 168 steroid-naive participants were enrolled in a 12-week trial of inhaled budesonide. Cluster analysis was performed in 389 participants who completed phase 2 with full data. Treatment responsiveness was compared between phenotypes.
Results |
Cluster analysis identified 5 phenotypes: moderate-to-severe childhood-onset atopic asthma, asthma-COPD overlap, obese-comorbid, mild childhood-onset atopic asthma, and mild intermittent. Bronchodilation after salbutamol was equal to or greater than that after ipratropium for all phenotypes. The moderate-to-severe childhood-onset atopic asthma, asthma-COPD overlap, and obese-comorbid phenotypes had greater efficacy with inhaled corticosteroid treatment than the mild intermittent group.
Conclusion |
Cluster analysis of adults with symptomatic airflow obstruction identifies 5 disease phenotypes, including asthma-COPD overlap and obese-comorbid phenotypes, and provides evidence that patients with the asthma-COPD overlap syndrome might benefit from inhaled corticosteroid therapy.
Le texte complet de cet article est disponible en PDF.Key words : Phenotype, asthma, chronic obstructive pulmonary disease, inhaled corticosteroid, bronchodilator
Abbreviations used : ACOS, ACQ, ATS, COPD, Feno, hsCRP, ICS, SGRQ
Plan
| The primary funder of the study was the Health Research Council of New Zealand (grant no. 10/174). Additional research funding was provided by AstraZeneca AB, Sweden; AstraZeneca Limited, New Zealand; and Genentech. |
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| Disclosure of potential conflict of interest: D. Bowles is employed by the Medical Research Institute of New Zealand, which has received funding from the HRC of New Zealand, and has received travel support from Boehringer Ingelheim. R. Beasley has received personal fees from GlaxoSmithKline, Cytos Biotechnology, Pharmaxis, Novartis, AstraZeneca, Boehringer Ingelheim, Nycomed, and Otsuka Pharmaceuticals and he has received grants from Novartis, AstraZeneca, Cephalon, Chiesi, and Genentech. The rest of the authors declare that they have no relevant conflicts of interest. |
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| Australian New Zealand Clinical Trials Registry no. ACTRN12610000666022. |
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