RT Journal Article
SR Electronic
T1 Heterogeneity of asthma according to blood inflammatory patterns
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 374
OP 380
DO 10.1136/thx.2008.103069
VO 64
IS 5
A1 Nadif, R
A1 Siroux, V
A1 Oryszczyn, M-P
A1 Ravault, C
A1 Pison, C
A1 Pin, I
A1 Kauffmann, F
YR 2009
UL http://thorax.bmj.com/content/64/5/374.abstract
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.