Blood inflammatory phenotypes were associated with distinct clinical expressions of asthma in adults from a large population-based cohort

Identification of asthma phenotypes using blood cell count

“…Furthermore, the presence of high neutrophil count was also related to more severe symptoms, and presence of chronic bronchitis. 6 Although the presence of concomitant COPD was not definitely excluded in this cohort, it seems that neutrophilic inflammation is probably related to a more systemic inflammatory process. However, we should always keep in mind that the elevation of neutrophil numbers might also be related to the use of inhaled corticosteroids.…”

“…Importantly, approximately half of asthmatic patients included in the cohort of Tsiavia et al were overweight and approximately one third were uncontrolled. 6 Obesity, increased age, and current smoking were associated to a high neutrophil count (regardless the number of blood eosinophils). Furthermore, the presence of high neutrophil count was also related to more severe symptoms, and presence of chronic bronchitis.…”

“…In eBioMedicine, the study of Tsiavia T et al, reports the identification of asthma inflammatory phenotypes based on complete blood count using a French population based cohort. 6 The authors have used the data of approximately 15.000 patients with current asthma from a large French population-based cohort and have identified four phenotypes based on the blood cell count. Importantly, among these phenotypes the most common was the low blood eosinophils/low blood neutrophils phenotype, accounting for 57% of patients and followed by the high blood eosinophil/low blood neutrophils, accounting for 33% of patients.…”

“…Similarly, in the study of Tsiavia et al, the low blood eosinophil/low blood neutrophil phenotype was associated with fewer day and night symptoms and fewer asthma exacerbations. 6 However, it is known that approximately 10-15% of patients with paucigranulocytic asthma, representing 5–10% of the treated asthmatics, have a poor asthma control and are still at increased risk for asthma exacerbations. 7 In these patients, it has been proposed that airway inflammation is probably related with different types of cells, such as macrophages or mast cells 8 a fact that could also explain the reason that, regardless the absence of granulocytes, some of these patients show minimal or no response to therapy.…”

“… 7 Accordingly, in the study of Tsiavia et al a significant proportion of patients in the low blood eosinophil/low blood neutrophil phenotype still present a high asthma symptom score and report day and night symptoms and asthma attacks. 6 Recognizing the possible different inflammatory pathways and the special clinical characteristics in this subgroup of patients of the paucigranulocytic phenotype, would probably result in increasing the potential for the development of novel therapeutic interventions resulting in the better management of these patients. However, we must point that the identification of paucigranulocytic asthma phenotype based on total blood count might not be always accurate as it has also been reported that inhaled corticosteroids might influence the number of blood eosinophils.…”