Περίληψη:
Background: Some patients with asthma present persistent airflow
limitation but their clinical and inflammatory characteristics have not
been extensively described. In this study we aimed to identify
differences in the clinical, functional and inflammatory characteristics
between patients with asthma with and without persistent airflow
obstruction.
Methods: Patients (n = 170) were consecutively recruited from two
tertiary Asthma Clinics. Patients’ demographics, pulmonary function
tests, inflammatory cells in induced sputum, bronchial
hyper-responsiveness (BHR, PD15 to methacholine) and treatment regimens
were recorded.
Results: Sixty patients (35.3%) presented persistent airflow
obstruction. Besides differences in lung function, patients with
persistent obstruction presented, lower methacholine PD20, higher
exhaled NO, and higher eosinophil and neutrophil counts in induced
sputum. The majority (71.7%) of the patients with persistent
obstruction fulfilled the ATS criteria for severe refractory asthma
(SRA), in contrast to 4.5% in the group without persistent obstruction.
A cluster analysis identified three clinically relevant clusters:
Cluster 1 (n = 56, not related to persistent airflow obstruction)
included non-atopic patients, who did not receive high-dose ICS without
SRA; Cluster 2 (n = 53, related to persistent airflow obstruction)
included atopic patients, receiving high-dose ICS and/or oral CS,
fulfilling SRA criteria; Cluster 3 (n = 61, not related to persistent
airflow obstruction) included atopic patients not receiving high-dose
ICS, without SRA.
Conclusions: Asthma patients with persistent airflow obstruction present
a distinct asthma phenotype, with significant differences in clinical,
functional and inflammatory characteristics compared to patients without
fixed airway obstruction. These patients present more often severe
refractory asthma and require more intense treatment. (C) 2015 Elsevier
Ltd. All rights reserved.
Συγγραφείς:
Konstantellou, Elissavet
Papaioannou, Andriana I.
Loukides,
Stelios
Patentalakis, George
Papaporfyriou, Anastasia and
Hillas, Georgios
Papiris, Spyros
Koulouris, Nikolaos and
Bakakos, Petros
Kostikas, Konstantinos
