Severity predictors of different phenotypes of T2 asthma endotype
- Authors: Khakimova M.R.1, Valeeva A.R.1, Kurmaeva N.S.1, Skorokhodkina O.V.1
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Affiliations:
- Kazan State Medical University
- Issue: Vol 20, No 3 (2023)
- Pages: 263-274
- Section: Original studies
- URL: https://journals.rcsi.science/raj/article/view/251320
- DOI: https://doi.org/10.36691/RJA14874
- ID: 251320
Cite item
Abstract
BACKGROUND: Epidemiological studies have showed that severe asthma is observed in 5–10% of patients. It is considered as a major social and economic burden for the healthcare system.
AIM: to perform a comparative analysis of clinical features of allergic and non-allergic phenotypes of T2 asthma and determine the most important predictors of severity.
MATERIALS AND METHODS: We studied 150 patients with asthma (ages 18–65). Of these, 61 were diagnosed with T2 endotype of asthma. Clinical examination and allergy testing were performed. The potential predictors of severe asthma included: asthma phenotype, gender, age (including elderly age), daytime/nocturnal symptoms per week, asthma exacerbations that required systemic corticosteroid therapy and hospitalisations, the volume of forced exhalation in the first second (FEV1; % of predicted value), body mass index (kg/m2), concomitant diseases, smoking status, sensitization to non-infectious allergens and blood eosinophil count.
RESULTS: Group 1 included 34 patients with allergic phenotype of asthma, group 2 ― 27 patients with non-allergic phenotype of T2 endotype of asthma. Univariate analyses revealed that subjects with non-allergic asthma were likely to have severe asthma (OR=3.14 [95% CI: 1.09–9.58]. Increased daytime symptoms per week, nocturnal symptoms per week, exacerbations that require systemic corticosteroids and hospitalisation were associated with asthma severity (OR=1.05 [95% CI: 1.01–1.11], 1.21 [95% CI: 1.05–1.45], 3.46 [95% CI: 1.68–10.19], 4 [95% CI: 1.75–12.32] and 4 [95% CI: 1.75–12.32], respectively), regardless of the disease phenotype. Lower FEV1 was associated with severe asthma (OR=0.96 [95% CI: 0.93–0.99]. Multivariate analysis showed that age, increased frequency of nocturnal symptoms, and lower FEV1 were associated with severe asthma.
CONCLUSION: The certain clinical differences of allergic and non-allergic asthma could be revealed when analyzing anamnestic data and clinical findings. Increased frequency of nocturnal symptoms, decreased FEV1 and age are the most significant predictors of severe T2 endotype of asthma.
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##article.viewOnOriginalSite##About the authors
Milyausha R. Khakimova
Kazan State Medical University
Author for correspondence.
Email: mileushe7@gmail.com
ORCID iD: 0000-0002-3533-2596
SPIN-code: 1875-3934
Russian Federation, Kazan
Alina R. Valeeva
Kazan State Medical University
Email: aliv05@mail.ru
ORCID iD: 0009-0007-6528-6774
SPIN-code: 1485-5669
Russian Federation, Kazan
Naira S. Kurmaeva
Kazan State Medical University
Email: nkurmaeva@inbox.ru
ORCID iD: 0000-0002-5505-4984
SPIN-code: 6678-2044
Russian Federation, Kazan
Olesya V. Skorokhodkina
Kazan State Medical University
Email: olesya-27@rambler.ru
ORCID iD: 0000-0001-5793-5753
SPIN-code: 8649-6138
MD, Dr. Sci. (Med.), Professor
Russian Federation, KazanReferences
- Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. 2023. Available from: www. ginasthma.org. Accessed: 18.07.2023.
- Clinical recommendations. Bronchial asthma. 2021. (In Russ). Available from: https://raaci.ru/dat/pdf/BA.pdf. Accessed: 23.05.2023.
- Sergeeva GR, Emelyanov AV, Leshenkova EV, Znakhurenko AA. Biomarkers of airways inflammation in patients with severe asthma in a real clinical practice. Pulmonology. 2020;30(4):437–445. (In Russ). doi: 10.18093/0869-0189-2020-30-4-437-445
- Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43(2):343–373. doi: 10.1183/09031936.00202013
- Nenasheva NM. Т2-high and T2-low bronchial asthma, endotype characteristics and biomarkers. Pulmonology. 2019;29(2):216–228. (In Russ). doi: 10.18093/0869-0189-2019-29-2-216-228
- Nagase H, Adachi M, Matsunaga K, et al. Prevalence, disease burden, and treatment reality of patients with severe, uncontrolled asthma in Japan. Allergol Int. 2020;69(1):53–60. doi: 10.1016/j.alit.2019.06.003
- López-Tiro J, Contreras-Contreras A, Rodríguez-Arellano ME, Costa-Urrutia P. Economic burden of severe asthma treatment: A real-life study. World Allergy Organ J. 2022;15(7):100662. doi: 10.1016/j.waojou.2022.100662
- Round table resolution. Lung diseases issue in Russia. In: X All-Russian Congress of Patients “Interaction of the authorities and the patient community as a basis for building patient-oriented healthcare in the Russian Federation”. Moscow, November 29, 2019. (In Russ). Available from: https://vspru.ru/media/853321/4.pdf. Accessed: 12.07.2023.
- Toppila-Salmi S, Lemmetyinen R, Chanoine S, et al. Risk factors for severe adult-onset asthma: A multi-factor approach. BMC Pulm Med. 2021;21(1):214 doi: 10.1186/s12890-021-01578-4
- Battaglia S, Benfante A, Spatafora M, Scichilone N. Asthma in the elderly: A different disease? Breathe (Sheff). 2016;12(1):18–28. doi: 10.1183/20734735.002816
- Pavlidis S, Takahashi K, Kwong F, et al. “T2-high” in severe asthma related to blood eosinophil, exhaled nitric oxide and serum periostin. Eur Respir J. 2019;53(1):1800938. doi: 10.1183/13993003.00938-2018
- Kozlova OA, Sekicki-Pavlenko OO. Theoretical framework for the socio-economic research on age and ageing in the context of contemporary demographic trends. Alter Economics. 2022;19(3): 442–463. (In Russ). doi: 10.31063/AlterEconomics/2022.19-3.3
- Pakkasela J, Ilmarinen P, Honkamäki J, et al. Age-specific incidence of allergic and non-allergic asthma. BMC Pulm Med. 2020;20(1):9. doi: 10.1186/s12890-019-1040-2
- Litonjua AA, Carey VJ, Burge HA, et al. Parental history and the risk for childhood asthma. Does mother confer more risk than father? Am J Respir Crit Care Med. 1998;158(1):176–181. doi: 10.1164/ajrccm.158.1.9710014
- Akdis CA, Agache I, editors. EAACI Global atlas of asthma. 2nd ed. Zurich: European Academy of Allergy and Clinical Immunology; 2021.
- Rönmark EP, Ekerljung L, Mincheva R, et al. Different risk factor patterns for adult asthma, rhinitis and eczema: Results from West Sweden Asthma Study. Clin Transl Allergy. 2016;(6):28. doi: 10.1186/s13601-016-0112-0
- Burte E, Bousquet J, Siroux V, et al. The sensitization pattern differs according to rhinitis and asthma multimorbidity in adults: The EGEA study. Clin Exp Allergy. 2017;47(4):520–529. doi: 10.1111/cea.12897
- Agache I, Rocha C, Beltran J, et al. Efficacy and safety of treatment with biologicals (benralizumab, dupilumab and omalizumab) for severe allergic asthma: A systematic review for the EAACI Guidelines: Recommendations on the use of biologicals in severe asthma. Allergy. 2020;75(5):1043–1057. doi: 10.1111/all.14235
- Matucci A, Vultaggio A, Maggi E, Kasujee I. Is IgE or eosinophils the key player in allergic asthma pathogenesis? Are we asking the right question? Respir Res. 2018;19(1):113. doi: 10.1186/s12931-018-0813-0
- Vujnovic SD, Domuz A. Epidemiological aspects of rhinitis and asthma: Comorbidity or united airway disease [Internet]. Asthma diagnosis and management: Approach based on phenotype and endotype. InTech; 2018. Available from: http://dx.doi.org/10.5772/intechopen.76773. Accessed: 07.07.2023.
- Chichikova NV. Bronchial asthma and diseases of the nasal cavity and paranasal sinuses: The unity of the pathological processes in the respiratory system. Russ Med J. 2015;(18):1132–1136. (In Russ).
- Kowalski ML, Agache I, Bavbek S, et al. Diagnosis and management of NSAID-Exacerbated Respiratory Disease (N-ERD): A EAACI position paper. Allergy. 2019;74(1):28–39. doi: 10.1111/all.13599
- Rajan JP, Wineinger NE, Stevenson DD, White AA. Prevalence of aspirin-exacerbated respiratory disease among asthmatic patients: A meta-analysis of the literature. J Allergy Clin Immunol. 2015; 135(3):676–681.e1. doi: 10.1016/j.jaci.2014.08.020
- Hakansson K, Thomsen SF, Konge L, et al. A comparative and descriptive study of asthma in chronic rhinosinusitis with nasal polyps. Am J Rhinol Allergy. 2014;28(5):383–387. doi: 10.2500/ajra.2014.28.4076
- Appleton SL, Adams RJ, Wilson DH, et al.; North West Adelaide Health Study Team. Central obesity is associated with nonatopic but not atopic asthma in a representative population sample. J Allergy Clin Immunol. 2006;118(6):1284–1291. doi: 10.1016/j.jaci.2006.08.011
- Romanet-Manent S, Charpin D, Magnan A, et al.; EGEA Cooperative Group. Allergic vs nonallergic asthma: What makes the difference? Allergy. 2002;57(7):607–613. doi: 10.1034/j.1398-9995.2002.23504.x
- De Nijs SB, Venekamp LN, Bel EH. Adult-onset asthma: Is it really different? Eur Respir Rev. 2013;22(127):44–52. doi: 10.1183/09059180.00007112
- Suruki RY, Daugherty JB, Boudiaf N, Albers FC. The frequency of asthma exacerbations and healthcare utilization in patients with asthma from the UK and USA. BMC Pulm Med. 2017;17(1):74. doi: 10.1186/s12890-017-0409-3
- Dyneva ME, Kurbacheva OM, Savlevich EL. Bronchial asthma in combination with chronic rhinosinusitis with nasal polyps: Epidemiology, prevalence and peculiarities of their relationship. Russ J Allergy. 2018;15(1):16–25. (In Russ). doi: 10.36691/RJA185
- Hirano T, Matsunaga K. Late-onset asthma: Current perspectives. J Asthma Allergy. 2018;(11):19–27. doi: 10.2147/JAA.S125948
- Fuseini H, Newcomb DC. Mechanisms driving gender differences in asthma. Curr Allergy Asthma Rep. 2017;17(3):19. doi: 10.1007/s11882-017-0686-1
- Solomon Y, Malkamu B, Berhan A, et al. Peripheral blood eosinophilia in adult asthmatic patients and its association with the severity of asthma. BMC Pulm Med. 2023;23(1):96. doi: 10.1186/s12890-023-02383-x
- Boonpiyathad T, Sözener ZC, Satitsuksanoa P, Akdis CA. Immunologic mechanisms in asthma. Semin Immunol. 2019; (46):101333. doi: 10.1016/j.smim.2019.101333
- Casciano J, Krishnan JA, Small MB, et al. Value of peripheral blood eosinophil markers to predict severity of asthma. BMC Pulm Med. 2016;16(1):109. doi: 10.1186/s12890-016-0271-8
- Oppenheimer J, Hoyte FC, Phipatanakul W, et al. Allergic and eosinophilic asthma in the era of biomarkers and biologics: Similarities, differences and misconceptions. Ann Allergy Asthma Immunol. 2022;129(2):169–180. doi: 10.1016/j.anai.2022.02.021