PT  - JOURNAL ARTICLE
AU  - Nadif, R
AU  - Siroux, V
AU  - Oryszczyn, M-P
AU  - Ravault, C
AU  - Pison, C
AU  - Pin, I
AU  - Kauffmann, F
TI  - Heterogeneity of asthma according to blood inflammatory patterns
AID  - 10.1136/thx.2008.103069
DP  - 2009 May 01
TA  - Thorax
PG  - 374--380
VI  - 64
IP  - 5
4099  - http://thorax.bmj.com/content/64/5/374.short
4100  - http://thorax.bmj.com/content/64/5/374.full
SO  - Thorax2009 May 01; 64
AB  - Rationale: There is increasing interest regarding asthma heterogeneity in relation to inflammatory patterns.Objectives: To assess phenotypic characteristics, in particular clinical presentation of the disease, in 381 well-characterised adults with asthma from the French Epidemiological study on the Genetics and Environment of Asthma (EGEA) according to their blood inflammatory pattern.Methods: Four blood inflammatory patterns were defined according to eosinophil (EOS) and neutrophil (NEU) count cut-off points. Samples with ⩾250 EOS/mm3 were classified as EOShi and those with ⩾5000 NEU/mm3 as NEUhi. Clinical characteristics include typical asthma and chronic obstructive pulmonary disease (COPD)-like symptoms, as well as composite quantitative scores addressing the activity of the disease.Results: A substantial number of those with asthma (56.2%) had the EOSlo pattern (<250 EOS/mm3). Patients with asthma who had the EOShi pattern had higher immunoglobulin E (IgE), a lower forced expiratory volume in 1 s (FEV1) and presented a more active asthma than those with the EOSlo pattern. Among those with the EOSlo pattern, neutrophil inflammation (NEUhi) was related to a less frequent positive skin prick test response (OR 0.44, 95% CI 0.20 to 0.96). Among those with the EOShi pattern, neutrophil inflammation did not explain current asthma or asthma activity, and was significantly related to nocturnal symptoms (OR 5.21, 95% CI 1.44 to 18.8) independently of age, sex, smoking and inhaled corticosteroid treatment. In non-smokers with asthma, COPD-like symptoms, in particular chronic phlegm, were more frequent in those with neutrophil inflammation, independent of eosinophil inflammation (OR 2.35, 95% CI 1.08 to 5.10).Conclusions: Besides eosinophilia, neutrophil inflammation assessed in the blood is related to specific characteristics of asthma. Considering simultaneously neutrophilic and eosinophilic inflammation may contribute to help to disentangle this complex disease.