Clinical evaluation of type 2 disease status in a real-world population of difficult to manage asthma using historic electronic healthcare records of blood eosinophil counts.
Adult
Anti-Asthmatic Agents
/ therapeutic use
Antibodies, Monoclonal, Humanized
/ therapeutic use
Asthma
/ blood
Cohort Studies
Electronic Health Records
Eosinophilia
/ blood
Eosinophils
Female
Forced Expiratory Volume
Fractional Exhaled Nitric Oxide Testing
Glucocorticoids
/ therapeutic use
Humans
Immunoglobulin E
/ blood
Leukocyte Count
Male
Middle Aged
Omalizumab
/ therapeutic use
Patient Selection
Sputum
/ cytology
Vital Capacity
asthma
eosinophils
epidemiology
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:
06 2021
06 2021
Historique:
revised:
18
01
2021
received:
28
10
2020
accepted:
22
01
2021
pubmed:
3
2
2021
medline:
1
2
2022
entrez:
2
2
2021
Statut:
ppublish
Résumé
Blood eosinophil measurement is essential for the phenotypic characterization of patients with difficult asthma and in determining eligibility for anti-IL-5/IL-5Rα biological therapies. However, assessing such measures over limited time spans may not reveal the true underlying eosinophilic phenotype, as treatment, including daily oral corticosteroid therapy, suppresses eosinophilic inflammation and asthma is intrinsically variable. We interrogated the electronic healthcare records of patients in the Wessex AsThma CoHort of difficult asthma (WATCH) study (UK). In 501 patients being evaluated in this tertiary care centre for difficult to control asthma, all requested full blood count test results in a 10-year retrospective period from the index WATCH assessment were investigated (n = 11,176). In 235 biological therapy-naïve participants who had 10 or more measures in this time period, 40.3% were eosinophilic (blood eosinophils ≥300 cells/µl) at WATCH enrolment whilst an additional 43.1%, though not eosinophilic at enrolment, demonstrated eosinophilia at least once in the preceding decade. Persistent eosinophilia was associated with worse post-bronchodilator airway obstruction and higher Fractional exhaled Nitric Oxide (FeNO). In contrast, the 16.6% of patients who never demonstrated eosinophilia at this blood eosinophil threshold showed preserved lung function and lower markers of Type 2 inflammation. This highlights the central role that type 2 inflammation, as indicated by blood eosinophilia, has in difficult asthma and suggests that longitudinal electronic healthcare record analysis can be an important tool in clinical asthma phenotyping, providing insight that may help understand disease progression and better guide more specific treatment approaches.
Sections du résumé
BACKGROUND
Blood eosinophil measurement is essential for the phenotypic characterization of patients with difficult asthma and in determining eligibility for anti-IL-5/IL-5Rα biological therapies. However, assessing such measures over limited time spans may not reveal the true underlying eosinophilic phenotype, as treatment, including daily oral corticosteroid therapy, suppresses eosinophilic inflammation and asthma is intrinsically variable.
METHODS
We interrogated the electronic healthcare records of patients in the Wessex AsThma CoHort of difficult asthma (WATCH) study (UK). In 501 patients being evaluated in this tertiary care centre for difficult to control asthma, all requested full blood count test results in a 10-year retrospective period from the index WATCH assessment were investigated (n = 11,176).
RESULTS
In 235 biological therapy-naïve participants who had 10 or more measures in this time period, 40.3% were eosinophilic (blood eosinophils ≥300 cells/µl) at WATCH enrolment whilst an additional 43.1%, though not eosinophilic at enrolment, demonstrated eosinophilia at least once in the preceding decade. Persistent eosinophilia was associated with worse post-bronchodilator airway obstruction and higher Fractional exhaled Nitric Oxide (FeNO). In contrast, the 16.6% of patients who never demonstrated eosinophilia at this blood eosinophil threshold showed preserved lung function and lower markers of Type 2 inflammation.
CONCLUSIONS
This highlights the central role that type 2 inflammation, as indicated by blood eosinophilia, has in difficult asthma and suggests that longitudinal electronic healthcare record analysis can be an important tool in clinical asthma phenotyping, providing insight that may help understand disease progression and better guide more specific treatment approaches.
Substances chimiques
Anti-Asthmatic Agents
0
Antibodies, Monoclonal, Humanized
0
Glucocorticoids
0
Omalizumab
2P471X1Z11
Immunoglobulin E
37341-29-0
mepolizumab
90Z2UF0E52
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
811-820Subventions
Organisme : National Institute for Health Research Southampton Biomedical Research Centre
Organisme : MRF
ID : MRF_MRF-009-0003-RG-HAITC
Pays : United Kingdom
Organisme : Novartis
Organisme : AAIR Charity
Organisme : Medical Research Council
ID : G0802804
Pays : United Kingdom
Informations de copyright
© 2021 The Authors. Clinical & Experimental Allergy published by John Wiley & Sons Ltd.
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