Clinical Characterization of the Frequent Exacerbator Phenotype in Asthma

Abstract

Background: Asthma exacerbation is episodic worsening of respiratory symptoms in conjunction with the deterioration of lung function, which may occur independently from the asthma severity hampering asthmatics’ quality of life. This study aimed to characterize the patient phenotype more prone to asthma exacerbation (oral corticosteroid burst ≥2 per year) to allow the proper identification of such patients. Methods: This real-life, observational, cross-sectional study evaluated 464 asthmatic patients stratified according to the asthma exacerbations experienced in the previous year. Clinical, functional, and blood parameters were retrieved from chart data and were representative of patients in stable conditions. Results: The frequent asthma exacerbator was more commonly female, suffered from chronic rhinosinusitis with nasal polyposis, had reduced lung function and peripheral oxygen saturation, and had increased daily activity limitations. These patients often had severe asthma and more frequently needed hospitalization in their lives. Furthermore, the frequent asthma exacerbator had higher concentrations of serum immunoglobulin E (IgE) and exhaled nitric oxide with cut-off risk values of 107.5 kU/L (OR = 4.1) and 43.35 ppb (OR = 3.8), respectively. Conclusions: This study illustrates the clinical features of the frequent asthma exacerbator phenotype. Nevertheless, serum IgE and exhaled nitric oxide could allow the identification of this phenotype and the establishment of an appropriate therapeutic approach.

Characterization of T2-Low and T2-High Asthma Phenotypes in Real-Life

“…The pulmonary function test assessed spirometry and lung volumes using a body plethysmograph (Vmax Encore 62, Carefusion, Würzburg, Germany), as stated by the European Respiratory Society [ 20 ]. Bronchodilation testing was performed according to validated criteria [ 9 ].…”

“…The T2-low asthma is uncommon in children and adolescents but occurs more frequently in late-onset asthmatics, females, and obese subjects [ 7 ]. Further, type 3 inflammation has been associated explicitly with frequent asthma exacerbations [ 8 , 9 ].…”

Using Computational Methods to Improve Integrated Disease Management for Asthma and Chronic Obstructive Pulmonary Disease: Protocol for a Secondary Analysis

“…One main goal in managing patients with asthma and patients with COPD is to reduce exacerbations, which expend approximately 40% to 75% of their total care cost [6][7][8] and accelerate their lung function decline [9]. Approximately one-fourth of patients with asthma and patients with COPD are prone to exacerbation [10][11][12][13][14], meaning that a patient has (1) ≥2 systemic corticosteroid orders in a year or (2) ≥1 emergency department visit or inpatient stay for asthma or COPD with systemic corticosteroid treatment in a year (Figure 1) [10,13,15]. These patients incur approximately two-thirds of all exacerbations [12,13,16] and experience a low quality of life; sleep disturbance; limitations of daily activities impacting independence, relationships, family life, socialization, and career; anxiety; distress; missed work with lost earnings; missed school; high care costs; high hospital use; intubation; and death [10,[17][18][19].…”

“…We deem a patient to have asthma in a given year if the patient has ≥1 asthma diagnosis code (International Classification of Diseases, Ninth Revision [ICD-9] 493.x or International Classification of Diseases, Tenth Revision [ICD-10] J45 and J46.x) in the year. The outcome is whether the patient became prone to exacerbation (ie, had either ≥2 systemic corticosteroid orders or ≥1 emergency department visit or inpatient stay with a principal diagnosis of asthma and systemic corticosteroid treatment) in the following year [10,15].…”

Alveolar Nitric Oxide and Peripheral Oxygen Saturation in Frequent Exacerbators with Asthma: A Pilot Study

“…We considered only severe AE, which are defined as those requiring systemic corticosteroids burst for more than 3 consecutive days [16]. Patients who had AE/y <2 have been classified as nFE (n = 55), whereas the term FE (n = 36) defined the patients who experienced AE/y ≥2 [3,22,23]. All analyses were performed on patients in stable disease conditions.…”