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Abstract
Introduction Recurrent exacerbations are a characteristic feature of uncontrolled asthma, often due to viral or bacterial infections. We have reported in a retrospective study that immune deficiency is common in asthma and correlates with reduced lung function. We set up a prospective study to determine if this predisposes to a more severe disease.
Aim Our aim is to ascertain if immune deficiency is associated with a more severe disease potentially with radiological changes and clinically with low lung function and frequent exacerbations.
Methods We prospectively collected data from new patients attending the regional asthma and fungal clinics. Demographics, markers of disease severity and specific antibody levels to Haemophilus iInfluenzae (HI), and Streptococcus pneumoniae (SP), were recorded. Patients with specific antibody deficiency (HI: ≤ 0.15 iu and SP: ≤ 0.35 iu to 6+ of 12 strains tested) received appropriate vaccination(s) in primary care (Pneumovax® and Meniotrix®), with repeat samples collected two months later. We also recorded blood and sputum eosinophil counts, radiological findings such as bronchiectasis and bronchial wall thickening, total IgE, smoking status, exacerbations in the last year and ITU admissions.
Results 101 patients were followed up (69 asthma, 32 fungal) 67 female, mean (SD) age 53 (15) years, FEV1 69 (21.9)% predicted, ICS dose 1818 (1244) μg, and BMI 29.9 (8.9) kg/m2. Specific antibody levels and responses to vaccination are presented in Figure 1. Immune deficiency at baseline and post vaccination did not correlate with lung function, radiological findings such as bronchial wall thickening or exacerbation frequency.
Conclusion Specific antibody deficiency is commonly seen in patients with asthma and fungal disease. Vaccination can provide protection and should be considered in this patient group. We need further analysis with a larger cohort of patients to study the association between antibody deficiency, lung function, radiological changes and disease progression.
Specific antibody levels at baseline and following vaccination for Haemophilus influenza and streptococcus pneumonia