PMID- 32605704
OWN - NLM
STAT- MEDLINE
DCOM- 20210624
LR  - 20210624
IS  - 1539-6304 (Electronic)
IS  - 1088-5412 (Linking)
VI  - 41
IP  - 4
DP  - 2020 Jul 1
TI  - Comparison of exacerbation phenotypes among patients with severe asthma.
PG  - e67-e79
LID - 10.2500/aap.2020.41.200029 [doi]
AB  - Background: Exacerbation phenotypes among patients with severe asthma have been 
      largely characterized during stable periods. Little is known about severe asthma 
      patients during exacerbation periods. Objective: To compare persistently frequent 
      exacerbators (PFE), non-persistently frequent exacerbators (NPFE), and infrequent 
      exacerbators (IFE) among patients with severe asthma during stable and 
      exacerbation periods. Methods: Patients with severe asthma who were admitted for 
      asthma exacerbations from 2011 to 2017 and on follow up at Singapore General 
      Hospital were recruited and categorized as PFEs (two or more exacerbations per 
      year over 2 consecutive years), NPFEs (two or more exacerbations in 1 year only), 
      or IFEs (fewer than two exacerbations per year over 2 consecutive years). 
      Demographic, clinical, and laboratory data were collected at baseline and during 
      exacerbation periods. Results: The participants were categorized as the 
      following: 20 PFEs, 36 NPFEs, and 57 IFEs, with no significant demographic 
      differences. The participants as PFEs (versus NPFEs and IFEs) were characterized 
      by having a higher prevalence of psychiatric disorders (25% versus 8% versus 5%; 
      p = 0.046), more comorbidities (7 versus 4 versus 2; p < 0.001), and a higher 
      steroid burden per year (1150 versus 456 versus 350 mg; p < 0.001). The 
      participants who were PFEs (versus IFEs) had a higher total immunoglobulin E 
      (IgE) level (625 versus 232 IU/mL; p = 0.046) and longer duration of admission 
      stay (3 versus 2 days; p = 0.009). All three groups had higher blood neutrophil 
      counts during exacerbation periods than during stable periods (p = 0.008 versus p 
      < 0.001 versus p = 0.004). Conclusion: The participants categorized as PFEs were 
      characterized by comorbidities, higher steroid burden, IgE levels, and longer 
      hospital stays. Exacerbations in the participants with severe asthma, regardless 
      of exacerbation phenotype, were characterized by neutrophilia. These findings 
      provided insights into potential therapeutic strategies to reduce exacerbations 
      in patients with severe asthma.
FAU - Soenjoyo, Karina Ruth
AU  - Soenjoyo KR
AD  - From the Duke NUS Medical School, Singapore.
FAU - Nadkarni, Nivedita
AU  - Nadkarni N
AD  - Centre for Quantitative Medicine, Duke-NUS Medical School Singapore; and.
FAU - Koh, Mariko Siyue
AU  - Koh MS
AD  - From the Duke NUS Medical School, Singapore.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Allergy Asthma Proc
JT  - Allergy and asthma proceedings
JID - 9603640
RN  - 0 (Anti-Asthmatic Agents)
RN  - 0 (Glucocorticoids)
RN  - 0 (Influenza Vaccines)
RN  - 0 (Pneumococcal Vaccines)
SB  - IM
MH  - Administration, Inhalation
MH  - Adult
MH  - Aged
MH  - Anti-Asthmatic Agents/therapeutic use
MH  - Asthma/drug therapy/*physiopathology
MH  - Disease Progression
MH  - Female
MH  - Forced Expiratory Volume
MH  - Glucocorticoids/therapeutic use
MH  - Hospitalization/*statistics & numerical data
MH  - Humans
MH  - Influenza Vaccines/therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Phenotype
MH  - Pneumococcal Vaccines/therapeutic use
MH  - Prospective Studies
MH  - Severity of Illness Index
MH  - Singapore
MH  - Vital Capacity
EDAT- 2020/07/02 06:00
MHDA- 2021/06/25 06:00
CRDT- 2020/07/02 06:00
PHST- 2020/07/02 06:00 [entrez]
PHST- 2020/07/02 06:00 [pubmed]
PHST- 2021/06/25 06:00 [medline]
AID - 10.2500/aap.2020.41.200029 [doi]
PST - ppublish
SO  - Allergy Asthma Proc. 2020 Jul 1;41(4):e67-e79. doi: 10.2500/aap.2020.41.200029.