Three phenotypes of adult-onset asthma
Three phenotypes of adult-onset asthma
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DOI：
10.1111/all.12136
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发表时间：
2013-05-01
期刊：
影响因子：
12.4
通讯作者：
Bel, E. H.
中科院分区：
文献类型：
--
作者：
Amelink, M.;de Nijs, S. B.;Bel, E. H.
基本原理 成人发病的哮喘在许多方面与儿童发病的哮喘不同。它的异质性更强，通常很严重，并且经常与肺功能丧失相关。为了确定成人发病哮喘的潜在机制并捕获疾病进展的预测因子，需要详细的表征和表型分析。目的 描述成人发病性哮喘的特征并确定成人发病性哮喘的亚表型。方法从荷兰阿姆斯特丹的一个学术和三个非学术肺部门诊诊所招募了 200 名成人发病（> 18 岁）哮喘患者（年龄 54（2675）岁）。这些患者在临床、功能和炎症标志物方面都有充分的特征。数据缩减后，进行 K 均值非层次聚类分析来识别成人发病哮喘的聚类。测量和主要结果 成人发病的哮喘患者主要是女性（61%）和非过敏性（55%）。在这组患者中，发现了三组成人发病的哮喘。第 1 组 (n=69) 由严重嗜酸性粒细胞炎症为主的哮喘患者组成，尽管接受了高强度抗炎治疗，但仍出现持续气流受限，症状评分相对较低。第二组的特点是肥胖女性，症状频繁，医疗保健利用率高，痰嗜酸性粒细胞低。第三组由轻度至中度、控制良好的哮喘患者组成，肺功能正常且炎症标志物较低。重复精度为98.2%。结论 在成人发病的哮喘患者中，可以识别出具有不同临床和炎症特征的三种亚表型。这些亚表型有助于了解潜在的病理学，并为临床医生提供个性化管理的指导。
Rationale Adult-onset asthma differs from childhood-onset asthma in many respects. It is more heterogeneous, often severe and frequently associated with loss of lung function. To identify underlying mechanisms of adult-onset asthma and to capture predictors of disease progression, detailed characterization and phenotyping is necessary. Objectives To characterize adult-onset asthma and identify subphenotypes of adult-onset asthma. Methods A cohort of 200 patients with adult-onset (>18year) asthma (age 54(2675)year) was recruited from one academic and three nonacademic pulmonary outpatient clinics in Amsterdam, the Netherlands. These patients were fully characterized with respect to clinical, functional and inflammatory markers. After data reduction, K-means nonhierarchical cluster analysis was performed to identify clusters of adult-onset asthma. Measurements and main results Patients with adult-onset asthma were predominately female (61%) and nonatopic (55%). Within this group of patients were identified three clusters of adult-onset asthma. Cluster 1 (n=69) consisted of patients with severe eosinophilic inflammation-predominant asthma and persistent airflow limitation despite high-intensity anti-inflammatory treatment, with relatively low symptom scores. The second cluster was characterized by obese women with frequent symptoms, high healthcare utilization and low sputum eosinophils. The third cluster consisted of patients with mild-to-moderate, well-controlled asthma with normal lung function and low inflammatory markers. Repeatability accuracy was 98.2%. Conclusions Amongst patients with adult-onset asthma, three subphenotypes can be identified with distinct clinical and inflammatory characteristics. These subphenotypes help to understand the underlying pathobiology and provide clinicians with directions for personalized management.