Asthma inflammatory phenotypes on four continents: most asthma is non-eosinophilic.
Asthma
HIC
LMIC
adolescents
children
inflammatory phenotypes
sputum induction
Journal
International journal of epidemiology
ISSN: 1464-3685
Titre abrégé: Int J Epidemiol
Pays: England
ID NLM: 7802871
Informations de publication
Date de publication:
19 04 2023
19 04 2023
Historique:
received:
04
11
2021
accepted:
14
08
2022
medline:
20
4
2023
pubmed:
31
8
2022
entrez:
30
8
2022
Statut:
ppublish
Résumé
Most studies assessing pathophysiological heterogeneity in asthma have been conducted in high-income countries (HICs), with little known about the prevalence and characteristics of different asthma inflammatory phenotypes in low-and middle-income countries (LMICs). This study assessed sputum inflammatory phenotypes in five centres, in Brazil, Ecuador, Uganda, New Zealand (NZ) and the United Kingdom (UK). We conducted a cross-sectional study of 998 asthmatics and 356 non-asthmatics in 2016-20. All centres studied children and adolescents (age range 8-20 years), except the UK centre which involved 26-27 year-olds. Information was collected using questionnaires, clinical characterization, blood and induced sputum. Of 623 asthmatics with sputum results, 39% (243) were classified as eosinophilic or mixed granulocytic, i.e. eosinophilic asthma (EA). Adjusted for age and sex, with NZ as baseline, the UK showed similar odds of EA (odds ratio 1.04, 95% confidence interval 0.37-2.94) with lower odds in the LMICs: Brazil (0.73, 0.42-1.27), Ecuador (0.40, 0.24-0.66) and Uganda (0.62, 0.37-1.04). Despite the low prevalence of neutrophilic asthma in most centres, sputum neutrophilia was increased in asthmatics and non-asthmatics in Uganda. This is the first time that sputum induction has been used to compare asthma inflammatory phenotypes in HICs and LMICs. Most cases were non-eosinophilic, including in settings where corticosteroid use was low. A lower prevalence of EA was observed in the LMICs than in the HICs. This has major implications for asthma prevention and management, and suggests that novel prevention strategies and therapies specifically targeting non-eosinophilic asthma are required globally.
Sections du résumé
BACKGROUND
Most studies assessing pathophysiological heterogeneity in asthma have been conducted in high-income countries (HICs), with little known about the prevalence and characteristics of different asthma inflammatory phenotypes in low-and middle-income countries (LMICs). This study assessed sputum inflammatory phenotypes in five centres, in Brazil, Ecuador, Uganda, New Zealand (NZ) and the United Kingdom (UK).
METHODS
We conducted a cross-sectional study of 998 asthmatics and 356 non-asthmatics in 2016-20. All centres studied children and adolescents (age range 8-20 years), except the UK centre which involved 26-27 year-olds. Information was collected using questionnaires, clinical characterization, blood and induced sputum.
RESULTS
Of 623 asthmatics with sputum results, 39% (243) were classified as eosinophilic or mixed granulocytic, i.e. eosinophilic asthma (EA). Adjusted for age and sex, with NZ as baseline, the UK showed similar odds of EA (odds ratio 1.04, 95% confidence interval 0.37-2.94) with lower odds in the LMICs: Brazil (0.73, 0.42-1.27), Ecuador (0.40, 0.24-0.66) and Uganda (0.62, 0.37-1.04). Despite the low prevalence of neutrophilic asthma in most centres, sputum neutrophilia was increased in asthmatics and non-asthmatics in Uganda.
CONCLUSIONS
This is the first time that sputum induction has been used to compare asthma inflammatory phenotypes in HICs and LMICs. Most cases were non-eosinophilic, including in settings where corticosteroid use was low. A lower prevalence of EA was observed in the LMICs than in the HICs. This has major implications for asthma prevention and management, and suggests that novel prevention strategies and therapies specifically targeting non-eosinophilic asthma are required globally.
Identifiants
pubmed: 36040171
pii: 6678972
doi: 10.1093/ije/dyac173
pmc: PMC10114118
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
611-623Subventions
Organisme : Medical Research Council
ID : MC_PC_19009
Pays : United Kingdom
Organisme : European Research Council
Pays : International
Organisme : Medical Research Council
ID : MC_PC_15018
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 088862
Pays : United Kingdom
Organisme : Medical Research Council
ID : G9815508
Pays : United Kingdom
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 21706/Z/19/Z
Pays : United Kingdom
Investigateurs
Neil Pearce
(N)
Lucy Pembrey
(L)
Steven Robertson
(S)
Karin van Veldhoven
(K)
Charlotte E Rutter
(CE)
Sinead Langan
(S)
Sarah Thorne
(S)
Donna Davoren
(D)
John Henderson
(J)
Susan Ring
(S)
Elizabeth Brierley
(E)
Sophie Fitzgibbon
(S)
Simon Scoltock
(S)
Amanda Hill
(A)
Alvaro Cruz
(A)
Camila Figueiredo
(C)
Mauricio Barreto
(M)
Cinthia Vila Nova Santana
(CVN)
Gabriela Pimentel
(G)
Gilvaneide Lima
(G)
Valmar Bião Lima
(VB)
Jamille Fernandes
(J)
Tamires Cana Brasil Carneiro
(TCB)
Candace Andrade
(C)
Gerson Queiroz
(G)
Anaque Pires
(A)
Milca Silva
(M)
Jéssica Cerqueira
(J)
Philip Cooper
(P)
Martha Chico
(M)
Cristina Ardura-Garcia
(C)
Araceli Falcones
(A)
Aida Y Oviedo
(AY)
Andrea Zambrano
(A)
Jeroen Douwes
(J)
Collin Brooks
(C)
Hajar Ali
(H)
Jeroen Burmanje
(J)
Harriet Mpairwe
(H)
Irene Nambuya
(I)
Pius Tumwesige
(P)
Milly Namutebi
(M)
Marble Nnaluwooza
(M)
Mike Mukasa
(M)
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of the International Epidemiological Association.
Références
BMC Pulm Med. 2006 Jun 23;6:15
pubmed: 16796729
Am J Respir Crit Care Med. 2007 Sep 15;176(6):565-74
pubmed: 17575099
Eur Respir J. 2008 Jan;31(1):143-78
pubmed: 18166595
Respiration. 2010;79(2):147-51
pubmed: 19816004
J Investig Allergol Clin Immunol. 1998 Nov-Dec;8(6):376-82
pubmed: 10028486
J Allergy Clin Immunol. 2019 Apr;143(4):1287-1294
pubmed: 29928921
Lancet. 2018 Jan 27;391(10118):350-400
pubmed: 28911920
Eur Respir J. 2010 Dec;36(6):1410-6
pubmed: 20530041
Eur Respir J. 2012 Dec;40(6):1324-43
pubmed: 22743675
BMC Pulm Med. 2016 Apr 05;16:46
pubmed: 27044366
Ther Adv Respir Dis. 2009 Aug;3(4):163-74
pubmed: 19661157
J Allergy Clin Immunol. 1998 Nov;102(5):S100-1
pubmed: 9819317
BMJ Open. 2017 Nov 28;7(11):e018186
pubmed: 29183929
Respirology. 2016 Apr;21(3):460-6
pubmed: 26693952
Pediatr Pulmonol. 2018 Sep;53(9):1208-1217
pubmed: 29870159
Eur Respir J. 2004 Sep;24(3):406-12
pubmed: 15358699
Eur Respir J. 2017 May 1;49(5):
pubmed: 28461300
Allergy. 2002 Dec;57(12):1171-9
pubmed: 12464046
ERJ Open Res. 2018 Aug 22;4(3):
pubmed: 30151371
J Asthma. 2010 Mar;47(2):166-9
pubmed: 20170324
Respirology. 2006 Jan;11(1):54-61
pubmed: 16423202
Lancet. 1958 Dec 13;2(7059):1245-7
pubmed: 13612182
Int J Epidemiol. 2013 Feb;42(1):111-27
pubmed: 22507743
Eur Respir J. 1998 Aug;12(2):315-35
pubmed: 9727780
Thorax. 2009 Jun;64(6):476-83
pubmed: 19237391
Int J Epidemiol. 2013 Feb;42(1):97-110
pubmed: 22507742
BMC Public Health. 2007 Feb 28;7:26
pubmed: 17397526
Int J Epidemiol. 1996 Jun;25(3):609-16
pubmed: 8671563
Thorax. 2002 Jul;57(7):643-8
pubmed: 12096210
Eur Respir J. 1998 Mar;11(3):599-605
pubmed: 9596109
Elife. 2019 Nov 15;8:
pubmed: 31729315
J Allergy Clin Immunol. 2009 Sep;124(3):615-7, 617.e1-2
pubmed: 19733302
Respir Res. 2010 Dec 01;11:167
pubmed: 21122116
Wellcome Open Res. 2019 Mar 14;4:51
pubmed: 31020050
Curr Allergy Asthma Rep. 2017 Mar;17(3):19
pubmed: 28332107
Thorax. 1999 Mar;54(3):268-72
pubmed: 10325905
Thorax. 2012 Aug;67(8):675-81
pubmed: 22379070
Eur Respir J. 1999 Oct;14(4):951-7
pubmed: 10573248
Am J Respir Crit Care Med. 1998 Jul;158(1):36-41
pubmed: 9655704