Clinical Phenotypes of Patients Hospitalized for an Asthma Exacerbation: Prognostic Implications

Zhang, Xin; Zhang, Li; Wang, Gang; Feng, Min; Liang, Rui; McDonald, Vanessa M.; Zhang, Hong Ping; He, Yu; Liang, Zong An; Wang, Lei; Marks, Guy B.; Li, Wei Min; Gibson, Péter G.

doi:10.1016/j.jaip.2020.09.031

Cited by 16 publications

(13 citation statements)

References 51 publications

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Section: Discussionmentioning

confidence: 99%

“…Our findings support those of a recent cluster analysis of a cohort of 825 hospitalized subjects with asthma, in which patients in cluster 3 (with older age, high daily inhaled corticosteroid dose, more intense maintenance medications, and severe or life-threatening exacerbations) characterized by a lower mean of blood eosinophils on admission (0.02x10 9 /L) presented the worst in-hospital prognosis with extended hospital stay and a higher need of ICU admission in comparison with the other two clusters (34). , with no differences between groups; D-dimer on admission showed similar results (B); the absolute lymphocyte count on admission was higher in the non-eosinopenia group, and both groups presented higher absolute lymphocyte counts on admission than at discharge (C); suggesting a correlation between lymphocytes and eosinophils (D).…”

Section: Discussionmentioning

confidence: 99%

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Eosinophils and Chronic Respiratory Diseases in Hospitalized COVID-19 Patients

et al. 2021

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BackgroundStudies on the role of eosinophils in coronavirus disease 2019 (COVID-19) are scarce, though available findings suggest a possible association with disease severity. Our study analyzes the relationship between eosinophils and COVID-19, with a focus on disease severity and patients with underlying chronic respiratory diseases.MethodsWe performed a retrospective analysis of 3018 subjects attended at two public hospitals in Madrid (Spain) with PCR-confirmed SARS-CoV-2 infection from January 31 to April 17, 2020. Patients with eosinophil counts less than 0.02×109/L were considered to have eosinopenia. Individuals with chronic respiratory diseases (n=384) were classified according to their particular underlying condition, i.e., asthma, chronic pulmonary obstructive disease, or obstructive sleep apnea.ResultsOf the 3018 patients enrolled, 479 were excluded because of lack of information at the time of admission. Of 2539 subjects assessed, 1396 patients presented an eosinophil count performed on admission, revealing eosinopenia in 376 cases (26.93%). Eosinopenia on admission was associated with a higher risk of intensive care unit (ICU) or respiratory intensive care unit (RICU) admission (OR:2.21; 95%CI:1.42-3.45; p<0.001) but no increased risk of mortality (p>0.05).ConclusionsEosinopenia on admission conferred a higher risk of severe disease (requiring ICU/RICU care), but was not associated with increased mortality. In patients with chronic respiratory diseases who develop COVID-19, age seems to be the main risk factor for progression to severe disease or death.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Eosinophils and Chronic Respiratory Diseases in Hospitalized COVID-19 Patients

et al. 2021

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“…At a glance, although heterogeneous inflammatory patterns are characteristic of severe asthma, the most common features found in NFA and FA episodes are evocative of a T2-driven patterns or a mixed T1 and T2 pattern-finally similar to that seen in the ward. 87,88 Figures 2 and 3 summarize all these findings at the small airway level, highlighting the specificities related to near-fatal asthma.…”

Section: Inflammatory Changes Characteristic Of Fa and Nfamentioning

confidence: 97%

“…The timing of the T2 cascade is unknown in near‐fatal and fatal asthma episodes, and the ideal target can only be suggested by deduction of what is known in other asthma events where immunopathological data are available. At a glance, although heterogeneous inflammatory patterns are characteristic of severe asthma, the most common features found in NFA and FA episodes are evocative of a T2‐driven patterns or a mixed T1 and T2 pattern—finally similar to that seen in the ward 87,88 …”

Section: Pathobiology Of Fatal and Near‐fatal Asthmamentioning

confidence: 98%

Will the asthma revolution fostered by biologics also benefit adult ICU patients?

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Charriot

Boissin

et al. 2020

Allergy

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Purpose: Asthma exacerbations are inflammatory events that rarely result in full hospitalization following an ER visit. Unfortunately, certain patients require prolonged support, including occasional external lung support through ECMO or ECCOR (with subsequent further exposure to other life-threatening issues), and some die. In parallel, biologics are revolutionizing severe asthma management, mostly in T2 high patients. Methods:We extensively reviewed the current unmet needs surrounding ICUadmitted asthma exacerbations, with a focus on currently available drugs and the underlying biological processes involved. We explored whether currently available T2-targeting drugs can reasonably be seen as potential players not only for relapse prevention but also as candidate drugs for a faster resolution of such episodes. The patient's perspective was also sought.Results: About 30% of asthma exacerbations admitted to the ICU do not resolve within five days. Persistent severe airway obstruction despite massive doses of corticosteroids and maximal pharmacologically induced bronchodilation is the main cause of treatment failure. Previous ICU admission is the main risk factor for such episodes and may eventually be considered as a T2 surrogate marker. Fatal asthma cases are hallmarked by poorly steroid-sensitive T2-inflammation associated with severe mucus plugging. New, fast-acting T2-targeting biologics (already used for preventing asthma exacerbations) have the potential to circumvent steroid sensitivity pathways and decrease mucus plugging. This unmet need was confirmed by patients who reported highly negative, traumatizing experiences. Conclusions:There is room for improvement in the management of ICU-admitted severe asthma episodes. Clinical trials assessing how biologics might improve ICU outcomes are direly needed.

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“…In recent years, there has been an increasing interest in the heterogeneity and phenotyping of asthma using cluster analysis in different asthma populations [16][17][18][19][20]. However, despite these well-conducted cluster analyses, the identification of phenotypes based on measurements of BC and nutritional status has not been previously reported.…”

Section: Introductionmentioning

confidence: 99%

Body Composition-Specific Asthma Phenotypes: Clinical Implications

et al. 2022

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Background: Previous studies have indicated the limitations of body mass index for defining disease phenotypes. The description of asthma phenotypes based on body composition (BC) has not been largely reported. Objective: To identify and characterize phenotypes based on BC parameters in patients with asthma. Methods: A study with two prospective observational cohorts analyzing adult patients with stable asthma (n = 541 for training and n = 179 for validation) was conducted. A body composition analysis was performed for the included patients. A cluster analysis was conducted by applying a 2-step process with stepwise discriminant analysis. Logistic regression models were used to evaluate the association between identified phenotypes and asthma exacerbations (AEs). The same algorithm for cluster analysis in the independent validation set was used to perform an external validation. Results: Three clusters had significantly different characteristics associated with asthma outcomes. An external validation identified the similarity of the participants in training and the validation set. In the training set, cluster Training (T) 1 (29.4%) was “patients with undernutrition”, cluster T2 (18.9%) was “intermediate level of nutrition with psychological dysfunction”, and cluster T3 (51.8%) was “patients with good nutrition”. Cluster T3 had a decreased risk of moderate-to-severe and severe AEs in the following year compared with the other two clusters. The most important BC-specific factors contributing to being accurately assigned to one of these three clusters were skeletal muscle mass and visceral fat area. Conclusion: We defined three distinct clusters of asthma patients, which had distinct clinical features and asthma outcomes. Our data reinforced the importance of evaluating BC to determining nutritional status in clinical practice.

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Clinical Phenotypes of Patients Hospitalized for an Asthma Exacerbation: Prognostic Implications

Cited by 16 publications

References 51 publications

Eosinophils and Chronic Respiratory Diseases in Hospitalized COVID-19 Patients

Eosinophils and Chronic Respiratory Diseases in Hospitalized COVID-19 Patients

Will the asthma revolution fostered by biologics also benefit adult ICU patients?

Body Composition-Specific Asthma Phenotypes: Clinical Implications

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