Type 2 biomarker expression (FeNO and blood eosinophils) is higher in severe adult‐onset than in severe early‐onset asthma

Lommatzsch, Marek; Klein, Maria; Stoll, Paul; Virchow, J. Christian

doi:10.1111/all.14997

Cited by 21 publications

(24 citation statements)

References 11 publications

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“…Our data agree with a study recently published by Lommatzsch et al [24] who reported a higher expression of type 2 markers (blood eosinophils and FeNO) in severe adult-onset asthma than in severe early-onset asthma. Mixed granulocytic subjects did not report increased ex-acerbation rate, while patients with eosinophilic pattern had higher number of exacerbations and a higher healthcare utilization in the year before evaluation [25].…”

Section: Discussionsupporting

confidence: 93%

Analysis of Patients with Asthma and Mixed Granulocytic Inflammatory Pattern in Sputum

et al. 2022

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Background: Patients with asthma usually present airway inflammation classified as eosinophilic, neutrophilic, mixed granulocytic, and paucigranulocytic pattern according to sputum inflammatory cells. Objective: The aim of the study was to analyze clinical and biological characteristics of patients with asthma and mixed granulocytic pattern in comparison with the other groups. Methods: Induced sputum was used to assess airway inflammation; lung function was evaluated as well as blood leukocytes and disease control. History of comorbidities was collected. Results: We retrospectively analyzed 231 subjects with asthma; patients with mixed granulocytic pattern were more frequently male compared with paucigranulocytic subjects, older than eosinophilic and paucigranulocytic patients with increased number and vitality of sputum cells compared to eosinophilic and paucigranulocytic patients and higher cumulative illness rating score, related to increased age. Smoking history, age of disease onset, and ICS treatment were not associated with higher mixed granulocytic pattern occurrence. Subjects with neutrophilic inflammation (mixed granulocytic and neutrophilic patterns considered altogether) were more frequently obese. In subjects under 67 years of age (median of the enrolled subjects), arterial hypertension was the only comorbidity more frequent in mixed granulocytic than in the other groups. 137/231 subjects were re-valuated during follow-up. Lung function of patients with mixed granulocytic, neutrophilic, and paucigranulocytic patterns improved less than that of eosinophilic patients. Conclusion: Aging and presence of comorbidities, in particular obesity and hypertension, are characteristics of patients with asthma and mixed granulocytic pattern. They could respond less well to treatment than eosinophilic patients.

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Section: Discussionsupporting

confidence: 93%

Analysis of Patients with Asthma and Mixed Granulocytic Inflammatory Pattern in Sputum

et al. 2022

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“…Along this line, a recent report showed that levels of total serum IgE and the prevalence of reported respiratory allergies were much lower in adult-onset patients than in EOA patients with severe asthma. 31 Instead, the study identified a distinct subtype of patients with high blood eosinophils with normal IgE levels, who were at risk for worse disease outcomes. At variance with most of the recent evidence in literature based on registries of patients with severe asthma, 11,31,32 our study examined a population with mild to moderate middle-aged asthmatic patients, which are the vast majority of patients observed in outpatient clinics.…”

Section: Discussionmentioning

confidence: 99%

“…31 Instead, the study identified a distinct subtype of patients with high blood eosinophils with normal IgE levels, who were at risk for worse disease outcomes. At variance with most of the recent evidence in literature based on registries of patients with severe asthma, 11,31,32 our study examined a population with mild to moderate middle-aged asthmatic patients, which are the vast majority of patients observed in outpatient clinics. This study is important because it specifically addresses the role of individual risk factors and comorbidities in stratifying asthmatic patients in real life.…”

Section: Discussionmentioning

confidence: 99%

Differences Between Early- and Late-Onset Asthma: Role of Comorbidities in Symptom Control

Turrin

Rizzo²,

Bonato³

et al. 2022

The Journal of Allergy and Clinical Immunology: In Practice

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“…High levels of F E NO have been positively correlated to the presence of atopy, eosinophilia, and early-onset atopic asthma, making F E NO a possible discriminant in phenotyping the asthmatic subpopulations [10, 11, 14, 31]. However, recent findings in severe asthma show that adult asthma onset patients can have higher F E NO concentrations than those with early asthma onset, due to a higher prevalence of T2 inflammation [32]. In consideration of these two opposing pieces of evidence, we found no relationship with the age of asthma onset (Table 1), but we observed that asthmatic patients with elevated F E NO were younger, as also described in the SARP study [10], and displayed higher blood eosinophilia (shown in Fig.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Low and High Exhaled Nitric Oxide Values in Asthma: A Real-World Study

et al. 2022

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Background: In asthma, exhaled nitric oxide (FENO) is a clinically established biomarker of airway T2 inflammation and an indicator for anti-inflammatory therapy. Objectives: The aim of the study was to identify, in an observational real-world cross-sectional study, the main characteristics of patients with asthma as classified by their FENO level. Method: We stratified 398 patients with stable mild-to-severe asthma according to FENO level as low (≤25 ppb) versus elevated (>25 ppb), subdividing the latter into two subgroups: moderately elevated (26–50 ppb) versus very high FENO (>50 ppb). Clinical, functional, and blood parameters were extrapolated from patients’ chart data and compared with the FENO stratification. Predictors of low and elevated FENO asthma were detected by logistic regression model. Results: Low BMI, higher blood eosinophilia, allergen poly-sensitization, the severest airflow obstruction (FEV1/FVC), and anti-leukotriene use are predictors of elevated FENO values in asthma, as well as persistent rhinitis and chronic rhinosinusitis with or without nasal polyps. Beyond these, younger age, more than 2 asthma exacerbations/year, higher airflow reversibility (post-bronchodilator ∆FEV1), and oral corticosteroid dependence are predictors of very high FENO values. In contrast, obesity, obstructive sleep apnoea syndrome, gastroesophageal reflux disease, arterial hypertension, and myocardial infarction are predictors of low FENO asthma. In our population, FENO correlated with blood eosinophils, airflow obstruction, and reversibility and negatively correlated with age and BMI. Conclusions: Stratifying patients by FENO level can identify specific asthma phenotypes with distinct clinical features and predictors useful in clinical practice to tailor treatment and improve asthmatic patients’ outcomes.

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Type 2 biomarker expression (FeNO and blood eosinophils) is higher in severe adult‐onset than in severe early‐onset asthma

Cited by 21 publications

References 11 publications

Analysis of Patients with Asthma and Mixed Granulocytic Inflammatory Pattern in Sputum

Analysis of Patients with Asthma and Mixed Granulocytic Inflammatory Pattern in Sputum

Differences Between Early- and Late-Onset Asthma: Role of Comorbidities in Symptom Control

Predictors of Low and High Exhaled Nitric Oxide Values in Asthma: A Real-World Study

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