Clinical characteristics of eosinophilic asthma exacerbations

Bjerregaard, Asger; Laing, Ingrid A.; Backer, Vibeke; Fally, Markus; Khoo, Siew-Kim; Chidlow, Glenys; Sikazwe, Chisha; Smith, David W.; Souëf, Peter Le; Porsbjerg, Celeste

doi:10.1111/resp.12905

Cited by 15 publications

(10 citation statements)

References 33 publications

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“…Chronic airway inflammation rich in eosinophils is an important feature seen in asthma. Airway and blood eosinophilia is associated with increased rates of asthma exacerbations and more intense treatment [1,2]. Mature eosinophils are blood circulating cells, which, after the appropriate stimulus, migrate into the target tissues, including the gastrointestinal tract, kidney, liver, or lungs [3] and are related to many different disorders, which are interrelated with severity of blood, tissues, and organs eosinophilia [4].…”

Section: Introductionmentioning

confidence: 99%

Blood Eosinophils Subtypes and Their Survivability in Asthma Patients

Januškevičius

Jurkevičiūtė

Janulaitytė

et al. 2020

Cells

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Eosinophils subtypes as lung-resident (rEOS) and inflammatory (iEOS) eosinophils are different in surface protein expression, functions, response to IL-5 and localization in lungs. rEOS- and iEOS-like eosinophils are found in blood; thus, we aimed to investigate their quantity and survivability in asthma patients. A total of 40 individuals were included: 10 steroid-free non-severe allergic asthma (AA), and 18 severe non-allergic eosinophilic asthma (SNEA) patients, the control group consisted of 12 healthy non-smoking subjects (HS). A bronchial challenge with Dermatophagoides pteronysinnus allergen was performed for AA patients and HS. Blood eosinophils subtyping was completed with magnetic beads’ conjugated antibodies against surface CD62L. Eosinophils adhesion to hTERT airway smooth muscle (ASM) cells was measured by evaluating their peroxidase activity and viability by annexin V and propidium iodide staining. We found that the predominant blood eosinophil subtype in AA patients was iEOS, while rEOS prevailed in SNEA patients (p < 0.05). Moreover, rEOS demonstrated higher adhesion intensity compared with iEOS in all investigated groups. Both eosinophils subtypes of SNEA patients had higher survivability over the AA group. However, iEOS survivability from AA and SNEA groups was higher compared with rEOS under standard conditions, when rEOS survivability increased after their incubation with ASM cells. Bronchial allergen challenge abolished the dominance of blood iEOS in AA patients and prolonged only iEOS survivability. Though the challenge did not affect the adhesion of any eosinophils subtypes, the direct dependence of rEOS and iEOS survivability on their interaction with ASM cells was revealed (p < 0.05). These findings provide the premise for eosinophils subtype-oriented asthma treatment.

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Section: Introductionmentioning

confidence: 99%

Blood Eosinophils Subtypes and Their Survivability in Asthma Patients

Januškevičius

Jurkevičiūtė

Janulaitytė

et al. 2020

Cells

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“…However, no significant difference in ICS treatment was seen between the two groups at any visit. Eosinophilic asthma (Th2 high) is associated with elevated levels of F eNO and AHR towards mannitol [ 6 – 8 , 23 ], thus the group of patients in this study seemingly have eosinophilic asthma. This current homogenous group of asthma patients is different from former studies, with doctor's diagnosis of asthma only and a mix of airway inflammation.…”

Section: Discussionmentioning

confidence: 99%

“…An association between sputum eosinophils and exhaled nitric oxide fraction ( F eNO ) has been reported [ 6 – 8 ]. Measurement of sputum eosinophils is comprehensive, expensive and not easy to perform in daily clinic, whereas level of airway inflammation measured by F eNO [ 6 ] is standardised, easy to perform and with an immediate result, and hence very useable in the daily clinic.…”

Section: Introductionmentioning

confidence: 99%

F_eNO-based asthma management results in faster improvement of airway hyperresponsiveness

et al. 2018

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Asthma is characterised by inflammation and respiratory symptoms. Current asthma treatment is based on severity of asthma symptoms only. Exhaled nitric oxide fraction (FeNO) is not recommended by the Global Initiative for Asthma guidelines. The aim was to compare the usefulness of a FeNO guided versus symptom-based treatment in achieving improved asthma control assessed by airway hyperresponsiveness (AHR).80 asthmatic patients were included in a double-blinded, parallel, randomised controlled trial with follow-up visits after 8, 24 and 36 weeks. Treatment was tailored using either a FeNO or Asthma Control Questionnaire (ACQ) based algorithm. Inclusion criteria were asthma symptoms and a provocative dose causing a 15% fall in forced expiratory volume in 1 s <635 mg mannitol. At each visit AHR, FeNO, ACQ and blood tests were performed.No differences between the two groups were found at inclusion. AHR from 8 to 24 weeks was improved in the FeNO group compared to the ACQ group (response dose ratio (RDR) geometric mean (95% CI): 0.02 (0.01–0.04) versus 0.05 (0.03–0.07), respectively, p=0.015). AHR to mannitol at 36 weeks showed no differences between the two groups (mean difference RDR (95% CI): −0.02 (−0.05–0.02), p=0.3). Total doses of inhaled steroid and number of exacerbations were similar (p>0.05).When using FeNO as a treatment management tool, lowering of airway responsiveness occurred earlier than using ACQ. However, airway responsiveness and asthma control after 9 months were similar.

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“…In those without a prior diagnosis of asthma, presence of risk factors for asthma exacerbation such as objective wheezing on chest exam, personal/family history of atopy, and decreased PEFR during symptomatic episodes can help in making a diagnosis. Increased sputum eosinophils (>3%) or blood eosinophilia (>300/µL) likely increase the risk of type 2 asthma exacerbation (15,16). Likewise an elevated fractional excretion of nitric oxide (FeNO) also raise the risk of an acute asthma exacerbation (10).…”

Section: Clinical Presentationmentioning

confidence: 99%

Inpatient Management of Bronchial Asthma for the Hospitalist – A Concise Review

Hunter¹,

Vaddi²,

Krvavac³

et al. 2019

Am J Hosp Med

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Asthma is a common inflammatory disease of the airways that leads to significant hospital utilization and health care cost around the world. Despite published guidelines, the diagnosis and treatment of acute asthma exacerbation varies widely due to inconsistent compliance with guidelines. We will review the evidence, guideline recommendations, clinical presentation, risk factors, and management of acute asthma exacerbations, including standard and advanced treatment options for refractory cases.

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Clinical characteristics of eosinophilic asthma exacerbations

Abstract: Our findings suggest that eosinophilic asthma exacerbations may be clinically more severe than NEEs, supporting the identification of these higher risk patients for specific interventions.

Cited by 15 publications

References 33 publications

Blood Eosinophils Subtypes and Their Survivability in Asthma Patients

Blood Eosinophils Subtypes and Their Survivability in Asthma Patients

F_eNO-based asthma management results in faster improvement of airway hyperresponsiveness

Inpatient Management of Bronchial Asthma for the Hospitalist – A Concise Review

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Clinical characteristics of eosinophilic asthma exacerbations

Abstract: Our findings suggest that eosinophilic asthma exacerbations may be clinically more severe than NEEs, supporting the identification of these higher risk patients for specific interventions.

Cited by 15 publications

References 33 publications

Blood Eosinophils Subtypes and Their Survivability in Asthma Patients

Blood Eosinophils Subtypes and Their Survivability in Asthma Patients

FeNO-based asthma management results in faster improvement of airway hyperresponsiveness

Inpatient Management of Bronchial Asthma for the Hospitalist – A Concise Review

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F_eNO-based asthma management results in faster improvement of airway hyperresponsiveness