Asthma and fixed airflow obstruction: Long-term trajectories suggest distinct endotypes.
Adult
Airway Obstruction
/ physiopathology
Airway Remodeling
Asthma
/ drug therapy
Bronchodilator Agents
/ therapeutic use
Disease Progression
Female
Follow-Up Studies
Forced Expiratory Volume
Glucocorticoids
/ therapeutic use
Humans
Leukotriene Antagonists
/ therapeutic use
Male
Middle Aged
Quality of Life
Severity of Illness Index
asthma
epidemiology
remodelling
Journal
Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology
ISSN: 1365-2222
Titre abrégé: Clin Exp Allergy
Pays: England
ID NLM: 8906443
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
17
10
2019
revised:
18
03
2020
accepted:
29
05
2020
pubmed:
25
7
2020
medline:
15
1
2022
entrez:
25
7
2020
Statut:
ppublish
Résumé
Long-term trajectories of asthma with fixed airflow obstruction (FAO) may reveal links to inflammatory endotypes. We investigated whether measures of asthma control and airway inflammation and remodelling differed by long-term FAO status in moderate-to-severe asthma. Adults enrolled in the Difficult Asthma Study assessed initially using serial Asthma Control Questionnaire (ACQ), exacerbation history, spirometry and sputum cytology over 12 months, as well as endoscopic bronchial biopsy with airway smooth muscle (ASM) quantification, were revaluated three or more years later with questionnaires and spirometry. FAO was defined as a persistent post-bronchodilator forced expired volume in one second (FEV Sixty-two participants (mean ± SD age 48 ± 11 years; 50% female; 75% atopic; asthma duration 24 ± 14 years) returned for follow-up assessment (median interval 7.9 years; IQR: 5.4-8.8 years). Compared to participants without FAO (n = 28), those with FAO at baseline and long-term follow-up (n = 18) had higher baseline sputum neutrophil content and ASM, and a higher exacerbation frequency that persisted at long-term follow-up. Sputum eosinophils, ACQ and long-term FEV In moderate-to-severe asthma, long-term FAO is characterized by neutrophilic sputum inflammation and airway remodelling, but FEV
Sections du résumé
BACKGROUND
Long-term trajectories of asthma with fixed airflow obstruction (FAO) may reveal links to inflammatory endotypes.
OBJECTIVE
We investigated whether measures of asthma control and airway inflammation and remodelling differed by long-term FAO status in moderate-to-severe asthma.
METHODS
Adults enrolled in the Difficult Asthma Study assessed initially using serial Asthma Control Questionnaire (ACQ), exacerbation history, spirometry and sputum cytology over 12 months, as well as endoscopic bronchial biopsy with airway smooth muscle (ASM) quantification, were revaluated three or more years later with questionnaires and spirometry. FAO was defined as a persistent post-bronchodilator forced expired volume in one second (FEV
RESULTS
Sixty-two participants (mean ± SD age 48 ± 11 years; 50% female; 75% atopic; asthma duration 24 ± 14 years) returned for follow-up assessment (median interval 7.9 years; IQR: 5.4-8.8 years). Compared to participants without FAO (n = 28), those with FAO at baseline and long-term follow-up (n = 18) had higher baseline sputum neutrophil content and ASM, and a higher exacerbation frequency that persisted at long-term follow-up. Sputum eosinophils, ACQ and long-term FEV
CONCLUSION
In moderate-to-severe asthma, long-term FAO is characterized by neutrophilic sputum inflammation and airway remodelling, but FEV
Substances chimiques
Bronchodilator Agents
0
Glucocorticoids
0
Leukotriene Antagonists
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
39-48Informations de copyright
© 2020 John Wiley & Sons Ltd.
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