Persistent airflow obstruction in patients with asthma: Characteristics of a distinct clinical phenotype

Konstantellou, Elissavet; Papaioannou, Andriana Ι.; Loukides, Stelios; Patentalakis, George; Papaporfyriou, Anastasia; Hillas, Georgios; Papiris, Spyros; Koulouris, Nikolaos; Bakakos, Petros; Κostikas, Κonstantinos

doi:10.1016/j.rmed.2015.09.009

Cited by 43 publications

(19 citation statements)

References 23 publications

(34 reference statements)

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“…Also increased bronchial obstruction at follow-up (<0.75) predicted a high dose of ICS. In agreement, in a recent cluster analysis of patients with and without fixed airflow obstruction, the patients with persistent obstruction were often users of high ICS [36]. In addition, patients with elevated markers of inflammation in their blood (eosinophils >0.2×10 9 /L and neutrophils >3.9×10 9 /L) despite of anti-inflammatory treatment were more likely users of high ICS dose, suggesting more steroid-resistant inflammation.…”

Section: Discussionsupporting

confidence: 69%

Comorbidities and elevated IL-6 associate with negative outcome in adult-onset asthma

et al. 2016

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The effect of systemic inflammation and comorbidities on treatment and outcome of adult-onset asthma remains unknown and is the objective of this study.As part of the Seinäjoki Adult Asthma Study (SAAS) with a 12-year follow-up, serum interleukin (IL)-6, high-sensitivity C-reactive protein (hsCRP) and lung function were measured and clinical information on comorbidities and medication collected from 170 patients with adult-onset asthma without chronic obstructive pulmonary disease.At follow-up visit, 54% of the patients had systemic inflammation as indicated by elevated IL-6 or hsCRP, 58% had at least one comorbidity and 30% at least two comorbidities (other than asthma related). Patients with systemic inflammation were treated with higher dose of inhaled corticosteroid (ICS) and they had lower lung function and higher blood neutrophils compared with patients without. Patients having ≥2 comorbidities had lower Asthma Control Test score and this association remained significant in adjusted analysis. Patients with both systemic inflammation and comorbidities showed poorest outcome of asthma. In multivariate regression analysis, high ICS dose was predicted by elevated IL-6, elevated blood neutrophils and eosinophils and poorer lung function at baseline and follow-up.Altogether, in patients with adult-onset asthma, elevated IL-6 was associated with use of high-dose ICS while multi-morbidity was linked to worse symptoms of asthma.

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Section: Discussionsupporting

confidence: 69%

Comorbidities and elevated IL-6 associate with negative outcome in adult-onset asthma

et al. 2016

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“…are the main risk factors for patterns of reduced lung function in children and adolescents with asthma. Our results are supported by previous studies with adults suggesting that frequent asthma exacerbation and severe asthma are risk factors for FAO in adults 31,32. Thus, the risk factors for FAO in children and adolescents seem to be quite similar to those observed in adults.…”

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confidence: 91%

Risk factors for fixed airflow obstruction in children and adolescents with asthma: 4‐Year follow‐up

Sousa

Cabral

Martins

et al. 2020

Pediatric Pulmonology

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Background Asthma is a disease with reversible bronchoconstriction; however, some patients develop fixed airflow obstruction (FAO). Previous studies have reported the incidence and risk factors of FAO in adults; however, the corresponding factors in children remain poorly understood. Aim To evaluate the incidence and risk factors of FAO in children and adolescents with asthma. Method Observational and prospective cohort study with a 4‐year follow‐up of clinically stable patients with asthma (from 6‐8 years old). Anthropometric data, history of asthma, number of hospitalizations, frequent exacerbations, asthma severity, asthma control, inhaled corticosteroid dose, atopy, and lung function were analyzed as potential risk factors for FAO. FAO was defined by a ratio of the forced expiratory volume in the first second to the forced vital capacity below the lower limit of normal, even after inhaled and oral corticosteroid treatment. Results Four hundred and twenty‐eight patients were recruited, and 358 were analyzed. The FAO incidence in children and adolescents with asthma was 9.5% (n = 34), starting at 10 years of age. Age, body mass index, hospitalizations for asthma, bronchodilator response, frequent exacerbations, length of exacerbations, and asthma severity were associated with FAO. Frequent exacerbations (odds ratio [OR] = 4.0; 95% confidence interval [CI] = 1.3‐11.7) and asthma severity categorized as steps 4 to 5 (OR = 3.5; 95% CI = 1.6‐7.6) remained risk factors. Conclusions Frequent exacerbations and asthma severity are the risk factors for FAO in children and adolescents with asthma.

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“… 25 – 28 The airflow limitation experienced in a majority of patients with asthma is usually reversible; a diagnosis of persistent airflow limitation is usually only characteristic of patients with severe asthma. 1 , 29 In patients with COPD, the typical pathogenic mechanisms include mucus hypersecretion, alveolar wall destruction, and fibrosis. Again, these complex processes are orchestrated by various cells and messenger molecules, including epithelial cells, macrophages, chemokines, monocytes, neutrophils, T-helper cells, and type 1 cytotoxic cells.…”

Section: What Do We Know About the Mechanisms Underlying Acos?mentioning

confidence: 99%

The asthma–COPD overlap syndrome: do we really need another syndrome in the already complex matrix of airway disease?

Κostikas

Clemens

Patalano

2016

COPD

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The term asthma–COPD overlap syndrome (ACOS) is one of multiple terms used to describe patients with characteristics of both COPD and asthma, representing ~20% of patients with obstructive airway diseases. The recognition of both sets of morbidities in patients is important to guide practical treatment decisions. It is widely recognized that patients with COPD and coexisting asthma present with a higher disease burden, despite the conceptual expectation that the “reversible” or “treatable” component of asthma would allow for more effective management and better outcomes. However, subcategorization into terms such as ACOS is complicated by the vast spectrum of heterogeneity that is encapsulated by asthma and COPD, resulting in different clinical clusters. In this review, we discuss the possibility that these different clusters are suboptimally described by the umbrella term “ACOS”, as this additional categorization may lead to clinical confusion and potential inappropriate use of resources. We suggest that a more clinically relevant approach would be to recognize the extreme variability and the numerous phenotypes encompassed within obstructive airway diseases, with various degrees of overlapping in individual patients. In addition, we discuss some of the evidence to be considered when making practical decisions on the treatment of patients with overlapping characteristics between COPD and asthma, as well as the potential options for phenotype and biomarker-driven management of airway disease with the aim of providing more personalized treatment for patients. Finally, we highlight the need for more evidence in patients with overlapping disease characteristics and to facilitate better characterization of potential treatment responders.

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Persistent airflow obstruction in patients with asthma: Characteristics of a distinct clinical phenotype

Cited by 43 publications

References 23 publications

Comorbidities and elevated IL-6 associate with negative outcome in adult-onset asthma

Comorbidities and elevated IL-6 associate with negative outcome in adult-onset asthma

Risk factors for fixed airflow obstruction in children and adolescents with asthma: 4‐Year follow‐up

The asthma–COPD overlap syndrome: do we really need another syndrome in the already complex matrix of airway disease?

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Persistent airflow obstruction in patients with asthma: Characteristics of a distinct clinical phenotype

Cited by 43 publications

References 23 publications

Comorbidities and elevated IL-6 associate with negative outcome in adult-onset asthma

Comorbidities and elevated IL-6 associate with negative outcome in adult-onset asthma

Risk factors for fixed airflow obstruction in children and adolescents with asthma: 4‐Year follow‐up

The asthma&ndash;COPD overlap syndrome: do we really need another syndrome in the already complex matrix of airway disease?

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The asthma–COPD overlap syndrome: do we really need another syndrome in the already complex matrix of airway disease?