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Identification of Subtypes of Refractory Asthma in Korean Patients by Cluster Analysis

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Abstract

Background

Refractory asthma, a subtype of asthma with uncontrolled symptoms despite antiasthma medications, is a heterogeneous syndrome with variable clinical features, presumably different etiologies, and pathophysiological mechanisms. The heterogeneity of refractory asthma, however, is poorly understood. We aimed to characterize refractory asthma and to improve our understanding of the heterogeneity of refractory asthma patients.

Methods

We identified refractory asthma patients (n = 96) as defined by the American Thoracic Society’s criteria from a cohort of Korean asthma patients (n = 2,187). Then, cluster analysis was conducted to classify subtypes of refractory asthma.

Results

Among the study group, 4.4 % (n = 96) of all asthma patients had refractory asthma. Cluster analysis identified four distinct groups of refractory asthma. Age at onset was younger in clusters 1 and 2 than in clusters 3 and 4. Patients in cluster 1 had the most well-preserved pulmonary function; patients in cluster 2 had a female predominance and the most severe airway obstruction; patients in cluster 3 were mostly female and had the most enhanced bronchial hyperresponsiveness; and patients in cluster 4 were most male and tended to be cigarette smokers.

Conclusions

The current results suggest that refractory asthma is a heterogeneous syndrome and could be classified into four subtypes. Underlying pathogenesis and therapeutic approaches may differ for the different subtypes and further research is needed.

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Abbreviations

ATS:

American Thoracic Society

BHR:

Bronchial hyperresponsiveness

BMI:

Body mass index

COPD:

Chronic obstructive pulmonary disease

ENFUMOSA:

European Network for Understanding Mechanism of Severe Asthma

FEV1 :

Forced expiratory volume in 1 s

FVC:

Forced vital capacity

GINA:

Global Initiative for Asthma

ICS:

Inhaled corticosteroid

LABA:

Long-acting beta-agonist

PC20 M:

Methacholine concentration that induced a 20 % decline of FEV1 from baseline FEV1

QOL:

Quality of life

SARP:

Severe Asthma Research Program

TENOR:

The Epidemiology and Natural history of asthma: Outcomes and treatment Regimens

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Acknowledgments

This study was supported by grants from the Korea Health 21 R&D Project, Ministry of Health, Welfare and Family Affairs (A090548 and A040153), Republic of Korea, to CSP, HBM, and YSC.

Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Division of Allergy and Respiratory Medicine, Genome Research Center for Allergy and Respiratory Diseases, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, 420-767, Republic of Korea

    An Soo Jang, Jong Sook Park, Sung Woo Park & Choon Sik Park

  2. Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, 138-736, Republic of Korea

    Hyouk-Soo Kwon, You Sook Cho, Yun Jeong Bae, Tae Bum Kim & Hee-Bom Moon

  3. Division of Allergy and Respiratory Medicine, Soonchunhyang University Seoul Hospital, Seoul, 140-743, Republic of Korea

    Soo-Taek Uh

  4. Division of Allergy and Respiratory Disease, Soonchunhyang University Cheonan Hospital, Cheonan, 330-100, Republic of Korea

    Jae-Sung Choi & Yong-Hoon Kim

  5. Division of Allergy and Respiratory Disease, Soonchunhyang University Gumi Hospital, Gyeongsangbuk-do, 330-100, Republic of Korea

    Hyeon-Kyu Hwang

Authors
  1. An Soo Jang
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  2. Hyouk-Soo Kwon
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  3. You Sook Cho
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  4. Yun Jeong Bae
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  5. Tae Bum Kim
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  6. Jong Sook Park
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  7. Sung Woo Park
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  8. Soo-Taek Uh
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  9. Jae-Sung Choi
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  10. Yong-Hoon Kim
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  11. Hyeon-Kyu Hwang
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  12. Hee-Bom Moon
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  13. Choon Sik Park
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Corresponding authors

Correspondence to You Sook Cho or Choon Sik Park.

Additional information

A. S. Jang and H.-S. Kwon contributed equally to this study.

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Jang, A.S., Kwon, HS., Cho, Y.S. et al. Identification of Subtypes of Refractory Asthma in Korean Patients by Cluster Analysis. Lung 191, 87–93 (2013). https://doi.org/10.1007/s00408-012-9430-8

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  • DOI: https://doi.org/10.1007/s00408-012-9430-8

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