A Large Subgroup of Mild-to-Moderate Asthma Is Persistently Noneosinophilic
A Large Subgroup of Mild-to-Moderate Asthma Is Persistently Noneosinophilic
复制标题
DOI：
10.1164/rccm.201109-1640oc
复制
发表时间：
2012-03-15
影响因子：
24.7
通讯作者：
Fahy, John V.
中科院分区：
文献类型：
--
作者：
McGrath, Kelly Wong;Icitovic, Nikolina;Fahy, John V.
理由：气道嗜酸性粒细胞增多是哮喘的典型症状，许多控制组治疗针对嗜酸性粒细胞增多的疾病。然而，哮喘在临床上是异质性的，哮喘患者的一个亚组没有气道嗜酸性粒细胞增多症。这个亚组的大小是不确定的，因为先前的研究没有检查痰细胞学的重复测量来确定哮喘患者是间歇性还是持续性痰嗜酸性粒细胞增多，以及他们是持续性非嗜酸性粒细胞增多。目的：了解非嗜酸性粒细胞哮喘表型的患病率和临床特征。方法：我们分析了995名哮喘患者的痰细胞学数据，这些患者参加了哮喘临床研究网络的临床试验，他们经常重复进行痰诱导和痰细胞学测量，并评估了对标准化哮喘治疗的反应。测量和主要结果：在横断面分析中，仅36%未服用吸入性皮质类固醇（ICS）的哮喘患者和17%接受吸入性皮质类固醇治疗的哮喘患者发现痰嗜酸性粒细胞增多（>= 2%嗜酸性粒细胞）；嗜酸性粒细胞的缺失经常被注意到，甚至在哮喘患者的疾病控制不佳的情况下。在未服用ICS的哮喘患者的重复测量分析中，22%的受试者每次都有痰嗜酸性粒细胞增多（持续性嗜酸性粒细胞增多）；31%的患者至少有一次嗜酸性粒细胞增多（间歇性嗜酸性粒细胞增多）；47%的患者在任何情况下都没有嗜酸性粒细胞增多（持续无嗜酸性粒细胞增多）。两周的联合抗炎治疗对嗜酸性粒细胞哮喘的气流阻塞有显著改善，但对持续性非嗜酸性粒细胞哮喘没有显著改善。相反，沙丁胺醇对嗜酸性粒细胞和非嗜酸性粒细胞哮喘的支气管扩张剂反应相似。结论：大约一半的轻中度哮喘患者有持续性嗜酸性粒细胞疾病，这是一种对目前可用的抗炎治疗反应不佳的疾病表型。
Rationale: Airway eosinophilia is typical of asthma, and many controller treatments target eosinophilic disease. Asthma is clinically heterogeneous, however, and a subgroup of people with asthma do not have airway eosinophilia. The size of this subgroup is uncertain because prior studies have not examined repeated measures of sputum cytology to determine when people with asthma have intermittent versus persistent sputum eosinophila and when they are persistently noneosinophilic.Objectives: To determine the prevalence and clinical characteristics of the noneosinophilic asthma phenotype.Methods: We analyzed sputum cytology data from 995 subjects with asthma enrolled in clinical trials in the Asthma Clinical Research Network where they had undergone sputum induction and measures of sputum cytology, often repeatedly, and assessment of responses to standardized asthma treatments.Measurements and Main Results: In cross-sectional analyses, sputum eosinophilia (>= 2% eosinophils) was found in only 36% of subjects with asthma not taking an inhaled corticosteroid (ICS) and 17% of ICS-treated subjects with asthma; an absence of eosinophilia was noted frequently, even in subjects with asthma whose disease was suboptimally controlled. In repeated measures analyses of people with asthma not taking an ICS, 22% of subjects had sputum eosinophilia on every occasion (persistent eosinophilia); 31% had eosinophilia on at least one occasion (intermittent eosinophilia); and 47% had no eosinophilia on every occasion (persistently noneosinophilic). Two weeks of combined antiinflammatory therapy caused significant improvements in airflow obstruction in eosinophilic asthma, but not in persistently noneosinophilic asthma. In contrast, bronchodilator responses to albuterol were similar in eosinophilic and noneosinophilic asthma.Conclusions: Approximately half of patients with mild-to-moderate asthma have persistently noneosinophilic disease, a disease phenotype that responds poorly to currently available antiinflammatory therapy.