Identifying the Clinical Pattern of Eosinophilic and Non-Eosinophilic Asthma subtype in adult patients with Bronchial Asthma

Abstract Background Context:- Asthma is a heterogenous disease with various phenotypes, it is the most common chronic disease characterized by airway limitation due to bronchospasm and airway inflammation associated with excessive mucus secretion from agitated mucus gland that occur due to air way hyper responiveness. Purpose of the study Comparison between eosinophilic and non-eosinophilic asthma patients. Patients and Methods 100 bronchial asthma patients of age ≥ 18 years old divided into2 groups according to blood eosinophilia. All patients were subjected to: history. Total Asthma Control Test. Spirometry. Sputum eosinophil count. IgE levels 6-Skin prick testing (SPT). Nasal endoscopy. Results the mean age of all patients was (35.4 ± 12.8) years, majority (61%) of patients were males,; the mean ACT score was (18.7 ± 2); 39% of cases have obstructive pattern by spirometry, 39% of cases had abnormal nasal endoscopy, SPT had significant relation with asthma, there is significant correlation between total IGE,sputum eosinophilia with eosinophilic asthma. Conclusion Blood eosinophils had the highest accuracy in the identification of sputum eosinophilia in asthma. Total IgE values and sutum eosinophilia were markedly increased in patients with eosinophilic asthma more than patients with non-eosinophilic asthma.

Download Full-text

Real-World Data Evaluation Of Total IgE, Specific IgE And Omalizumab Therapy In A Cohort Of Allergic Asthma Patients Treated In A Community-Based Practice

Journal of Immunology and Allergy ◽

10.37191/mapsci-2582-6549-1(3)-016 ◽

2020 ◽

Author(s):

Fortune O Alabi

Keyword(s):

Allergic Asthma ◽

Specific Ige ◽

Forced Expiratory Volume ◽

Act Scores ◽

Asthma Control Test ◽

Real World Data ◽

Total Ige ◽

Prick Test ◽

Negative Results ◽

Asthma Patients

Objective: In this study, we: (1) evaluated the correlation between total IgE and the presence of specific IgE; (2) compared the characteristics of patients with positive specific IgE to those with negative specific IgE; and, (3) analyzed the allergic testing results of patients on omalizumab and reported the effect of omalizumab on forced expiratory volume (FEV1) and asthma control test (ACT) results. Methods: Data from patients diagnosed with allergic asthma and seen at Florida Lung, Asthma & Sleep Specialists (FLASS) between January 2016 and June 2019 were analyzed. Parameters evaluated were total IgE, and levels of specific IgE to antigens in the ImmunoCAP test and skin prick test (SPT). Additional parameters for patients on omalizumab therapy for at least 6 months were FEV1, % predicted FEV1 and ACT results. Results: A total of 475 patients (114 males, 361 females) met the inclusion criteria. The mean age was 53 years (range: 17 to 89 years). Of these, 36 patients were not included in the analysis due to incomplete data. Mean total IgE was higher in patients with positive ImmunoCAP results compared to those with negative results (396 KU/L vs. 81.3 KU/L). There was a significant positive correlation between total IgE and levels of positive specific IgE in the ImmunoCAP test (p<0.0001, r=0.36, n=213 patients). The correlation between total IgE and levels of positive allergens in SPT was not significant (p=0.15, n=44 patients) Two positive reactions to allergens were seen in 22% of ImmunoCAP tests and 13% of SPT tests. There was no statistically significant improvement in FEV1 (p=0.097, CI -0.17 to 0.02) and % predicted FEV1 (p=0.109, CI -6.63 to 0.70) in patients who used omalizumab for at least 6 months. There was a statistically significant improvement in ACT scores (p=0.031, CI -4.21 to -0.21) in patients who used omalizumab for at least 6 months. Conclusion: Allergic asthma could be seen in patients who had an absence of specific IgE in ImmunoCAP and a negative reaction to SPT. The benefit of omalizumab therapy is not limited to allergic asthma patients with positive specific IgE.

Download Full-text

Biomarkers to identify sputum eosinophilia in different adult asthma phenotypes

European Respiratory Journal ◽

10.1183/09031936.00012415 ◽

2015 ◽

Vol 46 (3) ◽

pp. 688-696 ◽

Cited By ~ 83

Author(s):

Guus A. Westerhof ◽

Daniël A. Korevaar ◽

Marijke Amelink ◽

Selma B. de Nijs ◽

Jantina C. de Groot ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Operating Characteristics ◽

Total Ige ◽

Adult Asthma ◽

Asthma Phenotypes ◽

Sputum Eosinophilia ◽

Asthma Patients ◽

Outpatient Departments ◽

Nonobese Patients ◽

Blood Eosinophils

Several biomarkers have been used to assess sputum eosinophilia in asthma. It has been suggested that the diagnostic accuracy of these biomarkers might differ between asthma phenotypes. We investigated the accuracy of biomarkers in detecting sputum eosinophilia (≥3%) in different adult asthma phenotypes.Levels of eosinophils in blood and sputum, exhaled nitric oxide fraction (FeNO) and total immunoglobulin (Ig)E from 336 adult patients, enrolled in three prospective observational clinical trials and recruited at five pulmonology outpatient departments, were analysed. Areas under the receiver operating characteristics curves (AUC) for detecting sputum eosinophilia were calculated and compared between severe and mild, obese and nonobese, atopic and nonatopic and (ex-)smoking and never-smoking asthma patients.Sputum eosinophilia was present in 116 patients (35%). In the total group the AUC was 0.83 (95% CI 0.78–0.87) for blood eosinophils, 0.82 (0.77–0.87) for FeNO and 0.69 (0.63–0.75) for total IgE. AUCs were similar for blood eosinophils and FeNO between different phenotypes. Total IgE was less accurate in detecting sputum eosinophilia in atopic and obese patients than in nonatopic and nonobese patients.Blood eosinophils and FeNO had comparable diagnostic accuracy (superior to total IgE) in identifying sputum eosinophilia in adult asthma patients, irrespective of asthma phenotype such as severe, nonatopic, obese and smoking-related asthma.

Download Full-text

Phenotypes Determined by Cluster Analysis in Moderate to Severe Bronchial Asthma

Folia Medica ◽

10.1515/folmed-2017-0031 ◽

2017 ◽

Vol 59 (2) ◽

pp. 165-173 ◽

Cited By ~ 4

Author(s):

Vania M. Youroukova ◽

Denitsa G. Dimitrova ◽

Anna D. Valerieva ◽

Spaska S. Lesichkova ◽

Tsvetelina V. Velikova ◽

...

Keyword(s):

Cluster Analysis ◽

Bronchial Asthma ◽

Late Onset ◽

Skin Prick Testing ◽

Atopic Asthma ◽

Eosinophilic Asthma ◽

Asthmatic Patients ◽

Impaired Lung Function ◽

Serum Total Ige ◽

Personalized Approach

AbstractBackground:Bronchial asthma is a heterogeneous disease that includes various subtypes. They may share similar clinical characteristics, but probably have different pathological mechanisms.Aim:To identify phenotypes using cluster analysis in moderate to severe bronchial asthma and to compare differences in clinical, physiological, immunological and inflammatory data between the clusters.Patients and methods:Forty adult patients with moderate to severe bronchial asthma out of exacerbation were included. All underwent clinical assessment, anthropometric measurements, skin prick testing, standard spirometry and measurement fraction of exhaled nitric oxide. Blood eosinophilic count, serum total IgE and periostin levels were determined. Two-step cluster approach, hierarchical clustering method and k-mean analysis were used for identification of the clusters.Results:We have identified four clusters. Cluster 1 (n=14) - late-onset, non-atopic asthma with impaired lung function, Cluster 2 (n=13) - late-onset, atopic asthma, Cluster 3 (n=6) - late-onset, aspirin sensitivity, eosinophilic asthma, and Cluster 4 (n=7) - early-onset, atopic asthma.Conclusions:Our study is the first in Bulgaria in which cluster analysis is applied to asthmatic patients. We identified four clusters. The variables with greatest force for differentiation in our study were: age of asthma onset, duration of diseases, atopy, smoking, blood eosinophils, nonsteroidal anti-inflammatory drugs hypersensitivity, baseline FEV1/FVC and symptoms severity. Our results support the concept of heterogeneity of bronchial asthma and demonstrate that cluster analysis can be an useful tool for phenotyping of disease and personalized approach to the treatment of patients.

Download Full-text

Cockroach exposure and its allergy sensitization in asthma patients

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2021.1685 ◽

2021 ◽

Author(s):

Manoj Kumar ◽

Rajesh Kumar Gupta ◽

Raj Kumar ◽

Sonam Spalgais ◽

Anil Kumar Mavi ◽

...

Keyword(s):

Airway Obstruction ◽

Bronchial Asthma ◽

Periplaneta Americana ◽

Exposed Group ◽

Asthmatic Patients ◽

Asthma Patients ◽

History Of ◽

The Common ◽

The Mean ◽

Gina Guidelines

Asthma is a heterogeneous disease with distinct phenotypes. Serum tIgE, SSIgE and SPT are the methods of evaluating allergen sensitization. The present study evaluates the exposure and sensitization to cockroach (Periplaneta americana) antigens in asthma patients in a metropolitan city of India. The study enrolled 200 consecutive bronchial asthma patients, diagnosed as per GINA guidelines. As per history of exposure to cockroaches, the patients are divided in two groups as exposed and non-exposed asthmatic. All the enrolled subjects underwent SPT against common aeroallergens including cockroach, spirometry and estimation of tIgE level and SSIgE against cockroach. Out of 200 asthma patients, a total of 114 (57%) asthmatic were found SPT positive against one of the common aeroallergens, of which 68 (34%) showed SPT sensitivity against cockroach. A total of 103 (51.5%) patients were found exposed to cockroaches. In the cockroach exposed group, the mean serum tIgE was found significantly higher than the non-exposed group (569.31±224.64 vs 479.29±237 IU/ml; p=0.007). The mean SSIgE against cockroach in exposed groups was found not significant than non-expose group (4.87±11.19 vs 4.11±8.39 KUA/L; p=0.589). The mean tIgE was also not significant in atopic compared to non-atopic asthmatic (553.25±218.12 IU/ml vs 489.1±251.16 IU/ml; p=0.056). The mean SSIgE against cockroach was 5.66±10.45 KUA/L for atopic and 2.96±8.98 KUA/L for non-atopic (p=0.054). The airway obstruction was almost the same in both groups. Asthmatic patients who were exposed to cockroach and atopic had high tIgE, SSIgE levels and SPT positivity against cockroach antigen compared to non-exposed patients.

Download Full-text

Study on absolute eosinophil count correlation with severity of bronchial asthma

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191330 ◽

2019 ◽

Vol 7 (4) ◽

pp. 1229

Author(s):

Benjamin Lalrinpuia ◽

Naveen P.

Keyword(s):

Bronchial Asthma ◽

Peripheral Blood ◽

Eosinophil Count ◽

Tracheobronchial Tree ◽

Forced Expiratory Volume ◽

Eosinophil Infiltration ◽

Absolute Eosinophil Count ◽

Airway Caliber ◽

Asthma Patients ◽

The Mean

Background: Bronchial asthma is defined as chronic inflammatory disease of the airways that is characterized by increased responsiveness of the tracheobronchial tree to a multiplicity of stimuli. Eosinophil infiltration is a characteristic feature of asthmatic airways. It presents as an obstructive type of ventilator defect usually diagnosed from a reduced FEV1% (Forced Expiratory Volume) or from a reduced peak expiratory flow (PEF) associated with reduced airway caliber during expiration. Allergen inhalation results in a marked increase in activated eosinophils in the airways. Correlation between the degree of bronchial hyperresponsiveness (a cardinal feature of asthma) and peripheral blood eosinophilia has been observed in patients with dual response following allergen challenge.Methods: The study comprises a total number of 50 bronchial asthma patients of both sexes (male and female) between the age groups of 13-65 years. Based on severity, asthma patients were classified into mild, moderate and severe asthmatics, assessed by FEV1% computerized Spirometry Helios model number 701, recorders and medicare system. Peripheral blood sample was collected from each patient for absolute eosinophil count, the count was done on the same day.Results: The mean±SD absolute eosinophil count of 50 patients is 330±88.64 which is slightly above normal (300 cells/mm3). Author found that the mean±SD absolute eosinophil count of 405±83.16 in severe asthma patients is quite high, corresponding with a steep decline in the FEV1% 45.3±12.6.Conclusions: Absolute eosinophil count and FEV1% are important indicators of bronchial asthma severity and can even be used to predict disease progression.

Download Full-text

Heterogeneous Response of Airway Eosinophilia to Anti-IL-5 Biologics in Severe Asthma Patients

Journal of Personalized Medicine ◽

10.3390/jpm12010070 ◽

2022 ◽

Vol 12 (1) ◽

pp. 70

Author(s):

Maruša Kopač Šokić ◽

Matija Rijavec ◽

Peter Korošec ◽

Urška Bidovec-Stojkovič ◽

Izidor Kern ◽

...

Keyword(s):

Treatment Strategies ◽

Eosinophilic Inflammation ◽

Asthma Control Test ◽

Sputum Induction ◽

Immunological Parameters ◽

Eosinophilic Asthma ◽

Interleukin 5 ◽

Severe Eosinophilic Asthma ◽

Asthma Patients

Many questions concerning responders (R) and nonresponders (NR) in severe eosinophilic asthma (SEA) after blocking the IL-5 (interleukin 5) pathway are still not clear, especially regarding the early parameters of response to biologics in personalized treatment strategies. We evaluated 17 SEA patients treated with anti-IL-5 biologics (16 patients mepolizumab, one patient benralizumab) before the introduction of biologics, and at a week 16 follow-up. Clinical, cellular and immunological parameters in peripheral blood were measured in R and NR. Sputum induction with the measurement of cellular and immunological parameters was performed at 16 weeks only. There were 12 R and 5 NR to biologics. After 16 weeks, there was a significant improvement in percentages of FEV1 (p = 0.001), and asthma control test (ACT) (p = 0.001) in the R group, but not in NR. After 16 weeks, the eosinophils in induced sputum were 27.0% in NR and 4.5% in R (p = 0.05), with no difference in IL-5 concentrations (p = 0.743). Peripheral eosinophilia decreased significantly in NR (p = 0.032) and R (p = 0.002). In patients with SEA on anti-IL-5 therapy, there was a marked difference in airway eosinophilic inflammation between R and NR already at 16 weeks, after anti-IL-5 introduction.

Download Full-text

Role of a Community Pharmacy Service in Care of Bronchial Asthma Patients in Lithuania

Canadian Respiratory Journal ◽

10.1155/2018/6060581 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Arturas Nastaravičius ◽

Kristina Ramanauskienė

Keyword(s):

Asthma Control ◽

Bronchial Asthma ◽

Pharmacy Service ◽

Control Test ◽

Asthma Control Test ◽

Chronic Respiratory Diseases ◽

Asthmatic Patients ◽

Positive Effects ◽

Community Pharmacy Service ◽

Asthma Patients

Bronchial asthma is one of the most common chronic respiratory diseases, and its care is often complex. In this research, we tested the proposal that participation of pharmacists in the management of bronchial asthma can improve patient outcomes. A two-stage study was constructed consisting of a training element and a service element, using the Asthma Control Test and a structured questionnaire about the patients’ disease condition (based on the results of a qualitative study). The study was conducted in 21 pharmacies in Lithuania and involved 338 asthmatic patients (age 18–88 years). It was found that before the pharmacy service was provided, the average number of mistakes patients made in administration of asthma medications was 2.03; this number decreased to 1.12 after the service was provided (p<0.05). Disease control paralleled the improvement in number of mistakes: 26.1% of patients who previously exerted no control over the disease symptoms began to exert sufficient control over their asthma symptoms (Asthma Control Test >20) after the service was provided (p<0.05). The reduced number of mistakes probably can be attributed to the positive effects of the provided services. By reducing the number of patient mistakes, pharmacists may improve the outcomes of asthmatic patients.

Download Full-text

Effect of anulom vilom pranayama as an adjuvant treatment modality to improve the level of dyspnea in chronic asthma patients

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20180495 ◽

2018 ◽

Vol 5 (2) ◽

pp. 241

Author(s):

Jane Mary Jose ◽

Vadakken Devassy Thomas ◽

Kollanur Janso

Keyword(s):

Bronchial Asthma ◽

Adjuvant Treatment ◽

Treatment Modality ◽

Forced Expiratory Volume ◽

Female Dominance ◽

Asthma Patients ◽

Post Test ◽

History Of ◽

Dyspnea Score ◽

The Mean

Background: Dyspnea is the main symptom suffered by bronchial asthma patients who are even under medical treatment. This study was aimed to evaluate the use of alternate nostril breathing as an adjuvant treatment modality to improve the level of dyspnea in patients with bronchial asthma.Methods: Patients who were diagnosed to have bronchial asthma for more than 6 months with the modified Borg dyspnea score of more than 3 and forced expiratory volume (FEV1) for one second less than 80% included in the study. Anulom Vilom Pranayama was instructed to practice daily for 10 minutes for 4 weeks. The level of dyspnea in pre and post test was conducted using modified Borg dyspnea scale after doing six minute walk. Spirometer was used to assess the FEV1. The data was analysed statistically.Results: Twenty patients were included in the study. Majority belonged to the age group of 20-29 with female dominance and no history of smoking. There was a significant (p = 0.0001) reduction in dyspnea after practicing Anulom Vilom Pranayama for one month. The median of Borg dyspnea scale in the pre-test was 4.5 and that of post-test was 3.5. The mean FEV1 score in the pre-test was 57.20 and that of post-test was 68.75 which was found to be statistically significant (p=0.0001).Conclusions: One-month anulom vilom pranayama daily for 10 minutes improved the Borg dyspnea scale and FEV1 score. This indicates it as an effective intervention in reducing the level of dyspnea in chronic bronchial asthma patients.

Download Full-text

Elevated Plasma Level of Leukotrienes in Bronchial Asthma Patients: A Possible Clinical Relevance

Disease Markers ◽

10.1155/1994/121453 ◽

1994 ◽

Vol 12 (2) ◽

pp. 117-122 ◽

Cited By ~ 3

Author(s):

Mahmoud Mansour ◽

Nabil Farouk ◽

Abbas El Maragy ◽

Ibrahim Radwan ◽

Omar El-Ahmady

Keyword(s):

Bronchial Asthma ◽

Lipid Extraction ◽

Leukotriene B4 ◽

Mean Value ◽

Asthmatic Patients ◽

Healthy Donors ◽

Lipoxygenase Products ◽

Asthma Patients ◽

The Mean ◽

Chemical Mediators

Plasma from bronchial asthma patients and healthy controls was investigated for the content of lipoxygenase products. After lipid extraction using SEP-PAK C18Cartridges, the lipoxygenase products were measured by Enzyme-Immunoassay. Elevated chemotactic B4 was found in plasma from asthmatic patients with mean value (483±75) pmoUL, while the mean value in normal healthy donors was (140± 12.1) pmol/L (M±SE). The levels of spasmogenic cysteinyl containing leukotrienes were also very high in the bronchial asthma patients. Elevations of leukotriene B4and cysteinyl containing leukotrienes were detected during attacks of bronchial asthma. These results suggest that leukotriene B4 may be important in the pathogenesis of bronchial asthma and confirmed that peptidoleukotrienes playa role as chemical mediators during the asthmatic attack.

Download Full-text

Follow-up of patients with uncontrolled asthma: clinical features of asthma patients according to the level of control achieved (the COAS study)

European Respiratory Journal ◽

10.1183/13993003.01885-2015 ◽

2017 ◽

Vol 49 (3) ◽

pp. 1501885 ◽

Cited By ~ 5

Author(s):

Rosa Munoz-Cano ◽

Alfons Torrego ◽

Joan Bartra ◽

Jaime Sanchez-Lopez ◽

Rosa Palomino ◽

...

Keyword(s):

Lung Function ◽

Asthma Control ◽

Forced Expiratory Volume ◽

Uncontrolled Asthma ◽

Asthma Control Test ◽

Disease Evolution ◽

Factors Associated ◽

Asthma Patients ◽

The Mean ◽

Global Initiative

Our aim was to study the asthma control achieved in patients with uncontrolled asthma who had received appropriate treatment according to the Global Initiative for Asthma (GINA) 2010 (valid at the time the study was designed), and to analyse the factors associated with a lack of asthma control.This was a multicentre study in routine clinical practice performed in patients with uncontrolled asthma according to GINA 2010. At visit 1, we recorded demographics, asthma characteristics and spirometry. We assessed asthma control using GINA 2010 criteria and the Asthma Control Test (ACT). Treatment was optimised according to GINA 2010. At visit 2, 3 months later, we reassessed spirometry, asthma control and factors associated with failure to achieve control.We recruited 1299 patients with uncontrolled asthma (mean age 46.5±17.3 years, 60.7% women, 25.8% obese). The mean percentage of predicted forced expiratory volume in 1 s was 76.4±12.8% and the mean post-bronchodilator increase was 14.9±6.8%. We observed poor agreement between ACT and GINA 2010 when evaluating asthma control (kappa = −0.151). At visit 2, asthma in 71.2% of patients was still not fully controlled. Patients whose asthma remained uncontrolled were older, had a higher body mass index, greater disease severity, longer disease evolution and worse lung function.After treatment optimisation, most patients did not achieve optimal control according to GINA 2010. Risk factors for failure to achieve asthma control were time of disease evolution, severity, age, weight and lung function impairment (excluded in the GINA 2014).

Download Full-text