Subtypes of severe asthma based on a combination of blood eosinophil counts and levels of exhaled nitric oxide

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY(2020)

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摘要
Patients with severe asthma (SA) has been classified and examined based on blood eosinophil counts (b-Eos). B-Eos and fractional exhaled nitric oxide (FeNO) are major predictive markers for eosinophilic airway inflammation. High levels of FeNO also seems to express type 2 airway inflammation because of their production is largely upregulated by IL-13. Here, we determined whether classification based on combination of b-Eos and FeNO characterized SA. One hundred eight SAs defined on their criteria in Japanese Society of Allergology guideline were enrolled. Clinical data were obtained from medical records. Sputum induction (N=38) and FeNO were performed. Cut-off value of b-EOS and FeNO for eosinophil ratios in sputum ≥ 2% were analyzed by using receiver operating characteristic curve (ROC) analysis. SAs were divided into 4 subgroups based on the cut-off values. Characteristics of 4 SA subtypes were clinically evaluated. For the optimal cut-off values of sputum eosinophilia, ≥300/μL of b-EOS (82.0%, p = 0.001) and ≥38 ppb of FeNO (82.7%, p = 0.005) were applied. SAs with the high FeNO or high b-EOS subgroups had higher the prevalence of chronic sinusitis than those in the low FeNO and low b-EOS subgroups (p = 0.016). SAs with the high FeNO and high b-EOS subgroup had the highest frequency of severe acute exacerbations (p = 0.005). The classifications of SA based on airway and systemic type 2 inflammation biomarker demonstrated characteristic clinical features of SA subgroups. SA with both high type 2 inflammation biomarkers are consistently under unstable condition despite of optimal treatment.
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blood eosinophil counts,severe asthma
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