Type 2-High Severe Asthma with and without Bronchiectasis: A Prospective Observational Multicentre Study

Abstract

Introduction: Type 2-high severe asthma (T2-SA) is often associated with several comorbidities. To this extent, the coexistence of T2-SA and bronchiectasis (BE) is considered an emerging phenotype. Methods: We performed a prospective observational multicentre study, including T2-SA patients. Chest HRCT confirmed the presence of BE. Data on exacerbations, pulmonary function, Asthma Control Test (ACT), chronic mucus hypersecretion (CMH), chronic rhinosinusitis (CRS), oral corticosteroid (OCS) dosage, eosinophils in peripheral blood and FeNO were recorded. The Bhalla score was used for radiological assessment of T2-SA+BE patients and the Bronchiectasis Severity Index (BSI) was calculated. Results: A total of 113 patients (mean age 55 ± 11 years, 59.3% female) were enrolled. Copresence of BE was confirmed in 50/113 (44.2%) patients who identified the T2-SA+BE group. CRS and CRSwNP were more prevalent in T2-SA+BE vs T2-SA [respectively, 42/50 (84%) vs 37/63 (58.7%), p = 0.004 and 27/50 (54%) vs 27/63 (42.9%), p = 0.0165]. Furthermore, T2-SA +BE patients reported more CMH compared to T2-SA [29/50 (58%) vs 15/63 (23.8%), p = 0.0004], were more frequently on chronic OCSs intake [28/50 (56%) vs 22/63 (34.9%), p = 0.0357] and experienced more exacerbations/year [10 (4-12) vs 6 (4-12), p = 0.0487]. In a multivariate logistic regression model, the presence of CRS, CMH and daily OCS intake were associated with BE presence with a 78% (95% CI: 69-88) accuracy. Median Bhalla score was 18.3 (16-20) (Mild radiological severity). Median BSI was 6 (4-8) and only 6/50 (12%) had a BSI score ≥9. Significant inverse linear relationship between BSI and ACT (r = −0.6095, p < 0.0001), FEV 1 % (r = −0.3297, p = 0.0353) and FEV 1 mL (r = −0.4339, p = 0.0046) were found. Conclusion: Type 2 inflammation could have a causative role in BE development. Chest HRCT is mandatory when a diagnosis of T2-SA is made, especially in presence of CRS, CMH and chronic OCS intake. Early BE detection may be crucial to improve T2-SA patients' outcomes.

Case Report: Eosinophilic Bronchiolitis With Eosinophil ETosis in Mucus Plugs Successfully Treated With Benralizumab

“…Importantly, mucus plug and mucus hypersecretion are strongly associated with severe eosinophilic asthma (Dunican et al, 2018). Also, these manifestations are often accompanied with bronchiectasis with chronic airflow obstruction in severe asthma (Crimi et al, 2021). Thus, EETosis may be an optimal therapeutic target in refractory eosinophilic inflammation.…”

Female Reproductive Factors and the Risk of Bronchiectasis: A Nationwide Population-Based Longitudinal Study

“…Another important advantage of our study was that we considered comorbidity profiles that might affect the development of bronchiectasis in the analyses of the association of female sex hormones with bronchiectasis. Previous studies have shown that airway diseases such as asthma [ 36 , 37 ], COPD [ 38 ], and pulmonary tuberculosis [ 39 ] are major aetiologies of bronchiectasis. For example, Crimi et al showed a link between asthma and bronchiectasis by demonstrating that a type 2 inflammation could provide a causative role in the development of bronchiectasis [ 36 , 37 ].…”

“…Previous studies have shown that airway diseases such as asthma [ 36 , 37 ], COPD [ 38 ], and pulmonary tuberculosis [ 39 ] are major aetiologies of bronchiectasis. For example, Crimi et al showed a link between asthma and bronchiectasis by demonstrating that a type 2 inflammation could provide a causative role in the development of bronchiectasis [ 36 , 37 ]. Additionally, a recent longitudinal study showed that bronchiectasis could develop in subjects with COPD who had bronchial infections; post-tuberculosis bronchiectasis is known to be one of the leading aetiologies of bronchiectasis worldwide [ 38 , 39 ].…”

“…Cox proportional hazard regression analyses were conducted to evaluate the associations between the various reproductive factors and the incidence of bronchiectasis. The baseline demographics, metabolic comorbidities that might interact with the female reproductive factors (diabetes mellitus and dyslipidaemia), and pulmonary comorbidities that might affect the development of bronchiectasis (e.g., asthma [ 36 , 37 ], COPD [ 38 ], and tuberculosis [ 39 ]) were considered in the multivariable analyses. For premenopausal women, the multivariable model was adjusted for age, BMI, smoking history, regular exercise, income, age at menarche, parity, duration of breastfeeding, duration of OC use, and comorbidities (diabetes mellitus, dyslipidaemia, asthma or COPD, and tuberculosis).…”

Biological Therapy of Severe Asthma and Nasal Polyps

“…Consequently, experts can personalize treatment based on existing comorbidities before initiating treatment with an mAb CT score and ameliorate patient outcomes. [ 31 ].…”