Clinical profile of patients with adult-onset eosinophilic asthma

Abstract

Adult-onset eosinophilic asthma is increasingly recognised as a severe and difficult-to-treat subtype of asthma. In clinical practice, early recognition of patients with this asthma subtype is important because it may have treatment implications. Therefore, physicians need to know the distinct characteristics of this asthma phenotype. The objective of the present study was to determine the characteristic profile of patients with adult-onset eosinophilic asthma.130 patients with adult-onset (>18 years of age) asthma and high blood eosinophil counts (≥0.3×109 L−1) were compared with 361 adult-onset asthma patients with low (<0.3×109 L−1) blood eosinophils. Measurements included a series of clinical, functional and imaging parameters.Patients with high blood eosinophils were more often male, had less well controlled asthma and higher exacerbation rates, despite the use of higher doses of inhaled corticosteroids. They had higher levels of total IgE without more sensitisation to common inhaled allergens. In addition, these patients had worse lung function, and more often showed fixed airflow limitation, air trapping, nasal polyposis and abnormalities on sinus computed tomography scanning. Chronic rhinosinusitis, air trapping and male sex were three independent factors associated with blood eosinophilia (adjusted OR 3.8 (95% CI 1.7–8.1), 3.0 (95% CI 1.1–8.1) and 2.4 (95% CI 1.3–4.4), respectively).Patients with adult-onset asthma with elevated blood eosinophils exhibit a distinct profile, which can readily be recognised in clinical practice.

Variability of blood eosinophils in patients in a clinic for severe asthma

“…10,39,40 However, these analyses were based on levels obtained at a single point in time and fail to take variability into account. 10,39,40 However, these analyses were based on levels obtained at a single point in time and fail to take variability into account.…”

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

“…Defined as ‘chronic changes in breathing pattern that result in dyspnoea and other symptoms, in the absence or in excess of the magnitude of physiological respiratory or cardiac disease’ [69], DB is observed in up to 52% of subjects with difficult asthma. DB seems to be most common in the obese and non-eosinophilic phenotypes of severe asthma [70,71]. Patients typically report very excessive dyspnea at relatively low levels of physical activity, that is dyspnea that is disproportionate with the objective level of asthma severity.…”

Improving the diagnosis of eosinophilic asthma

“…In these patients, the clinical profile may have added value. A recent study looking at the typical clinical profile of adult patients with eosinophilic asthma found that patients with this phenotype differed from patients with non-eosinophilic asthma with respect to a number of distinctive clinical features [72]. As compared to non-eosinophilic asthma patients, those with the eosinophilic phenotype had more often adult-onset asthma, were more often male, and had more often chronic rhinosinusitis with nasal polyposis.…”