Characteristics of the European Thoracic Society/American Thoracic Society severe asthma definition as a determinant of future use of biologics/bronchial thermoplasty

被引：1

作者：

Nishiyama, Hirono ^{[1
]}

Kanemitsu, Yoshihiro ^{[1
]}

Fukumitsu, Kensuke ^{[1
]}

Takeda, Norihisa ^{[1
]}

Kurokawa, Ryota ^{[1
]}

Tajiri, Tomoko ^{[1
]}

Ito, Keima ^{[1
]}

Yap, Jenifer Maries Go ^{[1
]}

Fukuda, Satoshi ^{[1
]}

Uemura, Takehiro ^{[1
]}

Ohkubo, Hirotsugu ^{[1
]}

Maeno, Ken ^{[1
]}

Ito, Yutaka ^{[1
]}

Oguri, Tetsuya ^{[1
]}

Takemura, Masaya ^{[1
]}

Niimi, Akio ^{[1
]}

机构：

[1] Nagoya City Univ, Grad Sch Med Sci, Dept Resp Med Allergy & Clin Immunol, Nagoya, Aichi, Japan

来源：

ASIA PACIFIC ALLERGY | 2022年 / 12卷 / 02期

关键词：

Asthma; Molecular targeted therapy; Clinical decision-making; Severe uncontrolled asthma; Exacerbations; EXHALED NITRIC-OXIDE; LUNG-FUNCTION; EXACERBATIONS; GUIDELINES;

D O I：

10.5415/apallergy.2022.12.e13

中图分类号：

R392 [医学免疫学];

学科分类号：

100102 ;

摘要：

Background: International guidelines define severe uncontrolled asthma. Biologics or bronchial thermoplasty (Bio/BT) are recommended for such patients. Objectives: To determine which definitions of severe uncontrolled asthma are associated with an additional Bio/BT treatment in patients with severe uncontrolled asthma. Methods: Consecutive 107 asthmatics (including 15 patients for whom Bio/BT was introduced within 3 months after examination), classified as treatment step 4 according to the Global Initiative for Asthma 2015 guideline, were eligible for this analysis. Patients were assessed using the European Thoracic Society/American Thoracic Society (ERS/ATS) severe uncontrolled asthma guideline as defined by these 4 characteristics: poor control (ACT < 20), frequent exacerbations (>= 2/yr), admissions (>= 1/yr), and airflow limitation (forced expiratory volume in 1 second < 80% of predicted), along with comorbidities, and biomarkers, including blood granulocytes, fractional nitric oxide, and capsaicin cough reflex sensitivity (C-CS). These indices were compared between patients with and without Bio/BT introduction, and multivariate logistic regression analysis was performed to determine the association of the 4 definitions with treatment needs for Bio/BT. Results: Patients who were introduced to Bio/BT had heightened C-CS, heavier smoking history, and a greater prevalence of diabetes mellitus than those without (p < 0.05). Poor asthma control (ACT < 20), frequent exacerbations (>= 2/yr), and admissions (>= 1/yr) were relevant to the future use of Bio/BT in the multivariate regression analysis. Type 2-related biomarkers including absolute eosinophil counts were higher in patients in the Bio introduction group than in the BT introduction group. Meanwhile, there was no significant difference of the 4 characteristics of severe uncontrolled asthma definition between patients in the Bio and those in the BT groups. Conclusion: Although multiple factors such as treatment cost and asthma phenotypes affect treatment decision-making, the definition of poor asthma control, frequent exacerbations and admission by the ERS/ATS guidelines were important factors for an additional intensive treatment for severe uncontrolled asthma.

引用

页数：10

共 21 条

[1] Uniform definition of asthma severity, control, and exacerbations: Document presented for the World Health Organization Consultation on Severe Asthma [J].

Bousquet, Jean ;

Mantzouranis, Eva ;

Cruz, Alvaro A. ;

Ait-Khaled, Nadia ;

Baena-Cagnani, Carlos E. ;

Bleecker, Eugene R. ;

Brightling, Chris E. ;

Burney, Peter ;

Bush, Andrew ;

Busse, William W. ;

Casale, Thomas B. ;

Chan-Yeung, Moira ;

Chen, Rongchang ;

Chowdhury, Badrul ;

Chung, Kian Fan ;

Dahl, Ronald ;

Drazen, Jeffrey M. ;

Fabbri, Leonardo M. ;

Holgate, Stephen T. ;

Kauffmann, Francine ;

Haahtela, Tari ;

Khaltaev, Nikolai ;

Kiley, James P. ;

Masjedi, Mohammad R. ;

Mohammad, Yousser ;

O'Byrne, Paul ;

Partridge, Martyn R. ;

Rabe, Klaus F. ;

Togias, Alkis ;

van Weel, Christiaan ;

Wenzel, Sally ;

Zhong, Nanshan ;

Zuberbier, Torsten .

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 2010, 126 (05) :926-938

[2] Clinical Burden and Predictors of Asthma Exacerbations in Patients on Guideline-based Steps 4-6 Asthma Therapy in the TENOR Cohort [J].

Calhoun, William J. ;

Haselkorn, Tmirah ;

Mink, David R. ;

Miller, Dave P. ;

Dorenbaum, Alejandro ;

Zeiger, Robert S. .

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, 2014, 2 (02) :193-U222

[3] International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma [J].

Chung, Kian Fan ;

Wenzel, Sally E. ;

Brozek, Jan L. ;

Bush, Andrew ;

Castro, Mario ;

Sterk, Peter J. ;

Adcock, Ian M. ;

Bateman, Eric D. ;

Bel, Elisabeth H. ;

Bleecker, Eugene R. ;

Boulet, Louis-Philippe ;

Brightling, Christopher ;

Chanez, Pascal ;

Dahlen, Sven-Erik ;

Djukanovic, Ratko ;

Frey, Urs ;

Gaga, Mina ;

Gibson, Peter ;

Hamid, Qutayba ;

Jajour, Nizar N. ;

Mauad, Thais ;

Sorkness, Ronald L. ;

Teague, W. Gerald .

EUROPEAN RESPIRATORY JOURNAL, 2014, 43 (02) :343-373

[4] An Official ATS Clinical Practice Guideline: Interpretation of Exhaled Nitric Oxide Levels (FENO) for Clinical Applications [J].

Dweik, Raed A. ;

Boggs, Peter B. ;

Erzurum, Serpil C. ;

Irvin, Charles G. ;

Leigh, Margaret W. ;

Lundberg, Jon O. ;

Olin, Anna-Carin ;

Plummer, Alan L. ;

Taylor, D. Robin .

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2011, 184 (05) :602-615

[5] An Effect Size Primer: A Guide for Clinicians and Researchers [J].

Ferguson, Christopher J. .

PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE, 2009, 40 (05) :532-538

[6] Tiotropium Attenuates Refractory Cough and Capsaicin Cough Reflex Sensitivity in Patients with Asthma [J].

Fukumitsu, Kensuke ;

Kanemitsu, Yoshihiro ;

Asano, Takamitsu ;

Takeda, Norihisa ;

Ichikawa, Hiroya ;

Yap, Jennifer Manes Go ;

Fukuda, Satoshi ;

Uemura, Takehiro ;

Takakuwa, Osamu ;

Ohkubo, Hirotsugu ;

Maeno, Ken ;

Ito, Yutaka ;

Oguri, Tetsuya ;

Nakamura, Atsushi ;

Takemura, Masaya ;

Niimi, Akio .

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, 2018, 6 (05) :1613-+

[7] Japanese guidelines for adult asthma 2017 [J].

Ichinose, Masakazu ;

Sugiura, Hisatoshi ;

Nagase, Hiroyuki ;

Yamaguchi, Masao ;

Inoue, Hiromasa ;

Sagara, Hironori ;

Tamaoki, Jun ;

Tohda, Yuji ;

Munakata, Mitsuru ;

Yamauchi, Kohei ;

Ohta, Ken .

ALLERGOLOGY INTERNATIONAL, 2017, 66 (02) :163-189

[8] Comparison of the Asthma Control Test (ACT) with Lung Function, Levels of Exhaled Nitric Oxide and Control According to the Global Initiative for Asthma (GINA) [J].

Javier Alvarez-Gutierrez, Francisco ;

Francisco Medina-Gallardo, Juan ;

Perez-Navarro, Pablo ;

Jose Martin-Villasclaras, Juan ;

Martin Etchegoren, Bernardo ;

Romero-Romero, Beatriz ;

Manuel Praena-Fernandez, Juan .

ARCHIVOS DE BRONCONEUMOLOGIA, 2010, 46 (07) :370-377

[9] Independent Factors Contributing to Daytime and Nighttime Asthmatic Cough Refractory to Inhaled Corticosteroids [J].

Kanemitsu, Y. ;

Matsumoto, F. ;

Oguma, T. ;

Nagasaki, T. ;

Ito, I. ;

Izuhara, Y. ;

Tajiri, T. ;

Iwata, T. ;

Mishima, M. ;

Niimi, A. .

JOURNAL OF INVESTIGATIONAL ALLERGOLOGY AND CLINICAL IMMUNOLOGY, 2019, 29 (01) :30-39

[10] Increased Capsaicin Sensitivity in Patients with Severe Asthma Is Associated with Worse Clinical Outcome [J].

Kanemitsu, Yoshihiro ;

Fukumitsu, Kensuke ;

Kurokawa, Ryota ;

Takeda, Norihisa ;

Suzuki, Motohiko ;

Yap, Jennifer ;

Nishiyama, Hirono ;

Tajiri, Tomoko ;