Reduced bronchodilator reversibility correlates with non-type 2 high asthma and future exacerbations: A prospective cohort study - 05/09/22
Doi : 10.1016/j.rmed.2022.106924
Lei Liu a, b, c, 1, Xin Zhang a, b, c, 1, Li Zhang a, b, c, 1, Ying Liu a, b, c, Hong Ping Zhang a, Shu Zhen Zhao d, Jie Zhang e, Wei Jie Zhang f, Fang Wang g, Lei Wang a, Anny Xiaobo Zhou h, Wei Min Li b, ⁎ 
, Gang Wang b, c, ⁎ , Peter Gerard Gibson i
, Gang Wang b, c, ⁎ , Peter Gerard Gibson i a Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
b Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
c Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, 610041, Sichuan, China
d Outpatient Department, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
e Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Jilin University, Changchun 130041, Jilin, China
f Department of Respiratory Disease, Jilin Province People's Hospital, Changchun, 130021, Jilin, China
g Department of Pathogen Biology, Basic Medical College, Jilin University, Changchun, 130021, Jilin, China
h Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
i Priority Research Centre for Healthy Lungs and Centre of Excellence in Severe Asthma, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
∗Corresponding author. Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.Department of Respiratory and Critical Care MedicineClinical Research Center for Respiratory DiseaseWest China HospitalSichuan UniversityChengduSichuan610041China∗∗Corresponding author.
Abstract |
Background |
Given that airway obstruction in asthma is not always fully reversible, reduced bronchodilator reversibility (BDR) may be a special asthma phenotype.
Objective |
To explore the characteristics of BDRhigh/low phenotypes (defined using two BDR criteria) and their associations with asthma exacerbations (AEs).
Methods |
After baseline assessments, all patients were classified into BDRhigh or BDRlow phenotypes. This study consisted of 2 parts. Part I was a 12-month prospective observational cohort study designed to identify the clinical characteristics and associations with future AEs in BDRhigh/low phenotypes (n = 456). Part II, designed as a post hoc analysis of the data obtained in Part I, was conducted to assess the association between BDRhigh/low phenotypes and treatment responsiveness (n = 360).
Results |
Subjects with BDRlow phenotypes had better baseline asthma symptom control and was negatively associated with eosinophilic asthma and type 2 (T2) high asthma. During the 12-month follow-up, those with BDRlow phenotypes had a higher risk of severe AEs (SAEs) (guideline-based criterion: RRadj = 2.24, 95% CI = [1.25, 3.68]; Ward's criterion: RRadj = 2.46, 95% CI = [1.40, 4.00]) and moderate-to-severe AEs (MSAEs) (guideline-based criterion: RRadj = 1.83, 95% CI = [1.22, 2.56]; Ward's criterion: RRadj = 1.94, 95% CI = [1.32, 2.68]) in the following year according to logistic regression models. Similar findings were obtained with negative binominal regression models. BDRlow phenotype was a risk factor for an insensitive response to anti-asthma treatment (guideline-based criterion: ORadj = 1.96, 95% CI = [1.05, 3.65]; Ward's criterion: ORadj = 2.01, 95% CI = [1.12, 3.58]).
Conclusion |
We identified that BDRlow phenotype was associated with non-T2 high asthma and future AEs. These findings have clinically relevant implications for asthma management.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Airway obstruction in asthma is not always fully reversible. |
• | •Bronchodilator reversibility may be a phenotypic marker. |
• | •Reduced bronchodilator reversibility was associated with non-type 2 high asthma. |
• | •Reduced bronchodilator reversibility was related to increased risk of future exacerbations. |
Keywords : Asthma, Bronchodilator reversibility, Phenotypes, Exacerbations
Plan
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Vol 200
Article 106924- août 2022 Retour au numéro
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