Abstract
BackgroundInvestigating the endotypes of the different asthma phenotypes would help disease monitoring, prognosis determination, and improving asthma management standardization. This study aimed to classify asthma into four endotypes according to the allergic and eosinophilic characteristics and explore the phenotypes (clinical characteristics, pulmonary functions, and fractional expired nitric oxide (FeNO)) of each endotype.MethodsThis retrospective study included non-acute asthma patients treated at the First Hospital of Shanxi Medical University (05/2016–01/2018). The patients were classified into the eosinophilic allergic, eosinophilic non-allergic, non-eosinophilic allergic, and non-eosinophilic non-allergic asthma endotypes. Serum sIgE, lung function, FeNO, and induced sputum cytology were tested and compared among groups.ResultsOf the 171 included patients, 22 had eosinophilic allergic asthma, 17 had eosinophilic non-allergic asthma, 66 had non-eosinophilic allergic asthma, and 66 had non-eosinophilic non-allergic asthma. Lung function measurements (FEV1%, FEF25%, FEF50%, FEF75%, and FEF25–75%) showed that airway dysfunction was worse in eosinophilic non-allergic asthma than in the other three endotypes (all P < 0.001). In allergic asthma patients, eosinophilic asthma had worse airway dysfunction than non-eosinophilic asthma (all P < 0.05). Similar results were found in non-allergic asthma (all P < 0.01). The FeNO levels in eosinophilic allergic asthma were higher than in eosinophilic non-allergic and non-eosinophilic non-allergic asthma (both P = 0.001).ConclusionsFeNO can objectively reflect eosinophilic airway inflammation in asthma. Endotypic classification of asthma patients regarding the allergic and eosinophilic characteristics is conducive to the effective management of patients with asthma.
Highlights
Investigating the endotypes of the different asthma phenotypes would help disease monitoring, prognosis determination, and improving asthma management standardization
Characteristics of the patients Between May 2016 to January 2018, 171 patients with non-acute asthma were treated at the Outpatient Department of Respiration of the First Hospital of Shanxi Medical University
The findings showed that the patients were significantly younger in the eosinophilic allergic asthma endotype, the age of onset is usually in childhood and the patients tended to be allergic to multiple allergens, and they had a higher proportion of allergic comorbidities, including allergic rhinitis, sinusitis, eczema, urticaria etc
Summary
Investigating the endotypes of the different asthma phenotypes would help disease monitoring, prognosis determination, and improving asthma management standardization. The pathogenesis and clinical manifestations of asthma are very complex and heterogeneous [7], showing phenotypes and endotypes. The allergen stimulates the body to activate Th2 cells and release cytokines such as IL-4, IL-5 and IL-13, which act on airway epithelial cells, eosinophils, B lymphocytes and other inflammatory cells, showing the characteristics of allergy and eosinophilic associated inflammation and good response to ICS treatment. Non-Th2 type may release cytokines such as IL-17 and IFN-γ by activation of Th1 cells, and activate neutrophils such as IL-6, G-CSF and GM-CSF directly through CXCL8 or indirectly from airway epithelial cells, leading to neutrophilic inflammation and AHRs, including neutrophilic asthma, obesity-related asthma and smoking-related asthma [8]. Eosinophils, neutrophils and mast cells stimulate chronic inflammation, leading to basement membrane fibrosis, excessive mucus secretion, smooth muscle hypertrophy and angiogenesis, which damage the airway wall [9]
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