Severe asthma: Characteristics of patients in clinical practice


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Aim. To provide clinical characteristics of severe asthma (SA) patients encountered in clinical practice. Subjects and methods. A cross-sectional cohort study was performed to cover 119 outpatients aged 22—82 years. SA was diagnosed according to the ERS/ATS criteria (2014). Spirometry and bronchodilator reversibility testing were carried out; fractional exhaled nitric oxide (FeNO) was measured; inhalant allergen hypersensitivity (skin prick and blood specific IgE testing) and peripheral blood eosinophil counts were estimated. Asthma control and asthma-related quality of life were assessed. Results. 77% of the patients were found to have allergic asthma; in this case, house dust mites were leading allergens in the spectrum of sensitization. 82% of the patients were observed to have uncontrolled asthma and 76% had incompletely reversible bronchial obstruction. The airway eosinophilic inflammation markers (FeNO more than 25 ppb and eosinophil counts of more than 150 cells/µ) were elevated in 63% of the patients. Good compliance was noted in 61% of the patients. There were 27% of active smokers who had lower lung function and FeNO levels. The smokers showed a low compliance with inhaled glucocorticosteroid treatment. SA was concurrent with chronic obstructive pulmonary disease in 37% of the cases. Conclusion. SA is a heterogeneous disease. Traditional treatment is not always effective, as many patients, despite their treatment, have uncontrolled SA and continuously increased markers of airways eosinophilic inflammation. Monoclonal antibody therapy may promote success in treating this cohort of patients.

References

  1. Rabe KF, Adachi M, Lai CK, Soriano JB, Vermeire PA, Weiss KB, Weiss ST. Worldwide severity and control of asthma in children and adults: the global Asthma Insights and Reality surveys. J Allergol Clin Immunol. 2004;114:40-47. doi: 10.1016/j.jaci.2004.04.042.
  2. Novelli F, Latorre M, Vergura L, Caiaffa M, Camiciottoli G, Guarnieri G, Matucci A, Vianello A, Vultaggio A, Celi A, Cazzola M, Pierluigi P. Asthma control in severe asthmatics under treatment with omalizumab: A cross-sectional observational study in Italy. Pulmon Pharmacol Ther. 2015;31:123-129. doi: 10.1016/j.pupt.2014.09.007.
  3. The ENFUMOSA Study Group. The ENFUMOSA cross-sectional European multicentre study of the clinical phenotype of chronic severe asthma. Eur Respir J. 2003;22:470-477. doi: 10.1183/09031936.03.00261903.
  4. Bel EH, Sousa A, Fleming L, Bush A, Chung KF, Versnel J, Wagener AH, Wagers S, Sterk PJ, Compton CH. Diagnosis and definition of severe refractory asthma: an international consensus statement from the Innovative Medicine Initiative (IMI). Unbiased Biomarkers for the Prediction of Respiratory Disease Outcome (U-BIOPRED) Consortium, Consensus Generation. Thorax. 2011;66(10):910-917. doi: 10.1136/thx.2010,153643.
  5. Moore WC, Fitzpatrick AM, Li X, Hastie AT, Li H, Meyers DA, Bleecker ER. Clinical Heterogeneity in the Severe Asthma Research Program. Ann Am Thoracic Society. 2013;10Suppl:S118-124. doi: 10.1513/annalsats.201309-307aw.
  6. Chung K, Wenzel S, Brozek J, Bush A, Castro M, Sterk P, Adcock I, Bateman E, Bel E, Bleecker E, Boulet L, Brightling C, Chanez P, Dahlen S, Djukanovic R, Frey U, Gaga M, Gibson P. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43:343-373. doi: 10.1183/09031936.00202013.
  7. Чучалин А.Г., Огородова Л.М., Петровский Ф.И., Жестков А.В., Илькович М.М., Мартыненко Т.И., Ребров А.П., Реутова Л.Ю., Терещенко Ю.А., Фассахов Р.С., Черняк Б.А., Куликов Е.С. Базисная терапия тяжелой бронхиальной астмы у взрослых. Данные национального исследования НАБАТ. Пульмонология. 2004;6:68-77.
  8. Louie S, Zeki A, Schivo M, Chan A, Yoneda K, Avdalovic M, Morrissey B, Albertson T. The asthma — chronic obstructive pulmonary disease overlap syndrome: pharmacotherapeutic considerations. Expert Rev Clin Pharmacol. 2013;6(2):197-219. doi: 10.1586/ecp.13.2.
  9. Bateman E, Reddel H, van Zyl-Smit R, Agusti A. The asthma—COPD overlap syndrome: towards a revised taxonomy of chronic airways diseases? Lancet Respiratory Med. 2015;9(3):719-728. doi: 10.1016/s2213-2600(15)00254-4.
  10. Haldar P, Pavord I, Shaw D, Berry M, Thomas M, Brightling C, Wardlaw A, Green R. Cluster Analysis and Clinical Asthma Phenotypes. Am J Respir Critical Care Med. 2008;178(3):218-24. doi: 10.1164/rccm.200711-1754oc.
  11. Rosi E, Ronchi MC, Grazzini M, Duranti R, Scano G. Sputum analysis, bronchial hyperresponsiveness, and airway function in asthma: Results of a factor analysis. J Allergy ClinImmunol. 1999; 103:101-108. doi: 10.1016/s0091-6749(99)70496-3.
  12. Pavord I, Hilvering B. Biomarkers and inhaled corticosteroid responsiveness in asthmatic patients. J Allergy Clin Immunol. 2015; 135(4):884-885. doi: 10.1016/j.jaci.2015.01.031.
  13. Ortega H, Liu M, Pavord I, Liu M., Brusselle G, FitzGerald J, Chetta A, Humbert M, Katz L, Keene O, Yancey S, Chanez P. Mepolizumab Treatment in Patients with Severe Asthma. New Engl J Med. 2014;371:1198-1207. doi: 10.1056/nejmoa1403290.
  14. Dweik R, Boggs P, Erzurun S, Irvin C, Leigh M, Lundberg J, Olin A, Plummer A, Taylor D. An Official ATS Clinical Practice Guideline: Interpretation of Exhaled Nitric Oxide Levels (FENO) for Clinical Applications. Am J Respir Critical Care Med. 2011; 184:602-615. doi: 10.1164/rccm.9120-11st.
  15. Kupczyk M, Wenzel S. US and European severe asthma cohorts: what can they teach us about severe asthma? J Int Med. 2012;272:121-132.

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