Τίτλος:
Lung function fluctuation patterns unveil asthma and COPD phenotypes unrelated to type 2 inflammation
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: In all chronic airway diseases, the dynamics of airway function are influenced by underlying airway inflammation and bronchial hyperresponsiveness along with limitations in reversibility owing to airway and lung remodeling as well as mucous plugging. The relative contribution of each component translates into specific clinical patterns of symptoms, quality of life, exacerbation risk, and treatment success. Objective: We aimed to evaluate whether subgrouping of patients with obstructive airway diseases according to patterns of fluctuation in lung function allows identification of specific phenotypes with distinct clinical characteristics. Methods: We applied the novel method of fluctuation-based clustering (FBC) to twice-daily FEV1 measurements recorded over a 1-year period in a mixed group of 134 adults with mild-to-moderate asthma, severe asthma, or chronic obstructive pulmonary disease from the European BIOAIR cohort. Results: Independently of clinical diagnosis, FBC divided patients into 4 fluctuation-based clusters with progressively increasing alterations in lung function that corresponded to patterns of increasing clinical severity, risk of exacerbation, and lower quality of life. Clusters of patients with airway disease with significantly elevated levels of biomarkers relating to remodeling (osteonectin) and cellular senescence (plasminogen activator inhibitor-1), accompanied by a loss of airway reversibility, pulmonary hyperinflation, and loss of diffusion capacity, were identified. The 4 clusters generated were stable over time and revealed no differences in levels of markers of type 2 inflammation (blood eosinophils and periostin). Conclusion: FBC-based phenotyping provides another level of information that is complementary to clinical diagnosis and unrelated to eosinophilic inflammation, which could identify patients who may benefit from specific treatment strategies or closer monitoring. © 2021
Συγγραφείς:
Delgado-Eckert, E.
James, A.
Meier-Girard, D.
Kupczyk, M.
Andersson, L.I.
Bossios, A.
Mikus, M.
Ono, J.
Izuhara, K.
Middelveld, R.
Dahlén, B.
Gaga, M.
Siafakas, N.M.
Papi, A.
Beghe, B.
Joos, G.
Rabe, K.F.
Sterk, P.J.
Bel, E.H.
Johnston, S.L.
Chanez, P.
Gjomarkaj, M.
Howarth, P.H.
Niżankowska-Mogilnicka, E.
Dahlén, S.-E.
Frey, U.
Περιοδικό:
Allergy: European Journal of Allergy and Clinical Immunology
Εκδότης:
Mosby Year Book Inc
Λέξεις-κλειδιά:
advanced glycation end product receptor; alpha 1 antichymotrypsin; B cell activating factor; biological marker; bronchodilating agent; C reactive protein; CD40 ligand; chitinase 3 like protein 1; chymase; complement component C9; dipeptidyl peptidase IV; interleukin 6; macrophage inflammatory protein 3; osteonectin; plasminogen activator inhibitor 1; prednisone; stromelysin; thymic stromal lymphopoetin; transcription factor RUNX2; unclassified drug, adult; Article; asthma; cell aging; chronic obstructive lung disease; clinical feature; cluster analysis; cohort analysis; controlled study; disease exacerbation; eosinophil; female; follow up; forced expiratory volume; human; hyperinflation; lung diffusion capacity; lung function; major clinical study; male; measurement; peak expiratory flow; phenotype; quality of life; risk assessment; aged; airway remodeling; asthma; chronic obstructive lung disease; clinical trial; inflammation; lung function test; middle aged; multicenter study; pathology; pathophysiology, Adult; Aged; Airway Remodeling; Asthma; Female; Humans; Inflammation; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive; Respiratory Function Tests
DOI:
10.1016/j.jaci.2020.12.652
