Abstract
Background Cigarette smoking and Th2-inflammation are both crucial in the pathogenesis of asthma. However, it is unknown whether smoking can affect the association between Th2-inflammation and small airway obstruction in adults with asthma. Methods Adults diagnosed with asthma by a pulmonologist according to Global Initiative for Asthma guidelines were recruited from September 2016 to April 2018 to participate in this study. Participants were divided into two groups, the small airway obstruction group (those with FEF25–75% predicted value ≤ 65%) and the normal small airway function group (those with FEF25–75% predicted value > 65%). Final data analysis included 385 and 93 people in the Obstructive Group and the Normal Group, respectively. Total serum IgE level and blood eosinophil count were used as biomarkers of the Th2 phenotype. Results The Obstructive Group had a larger fraction of smokers, higher blood eosinophil count, and lower lung function than the Normal Group. Current-smoking status was associated with an increased risk of small airway obstruction (adjusted odds ratio = 4.677, 95% confidence interval [1.593–13.730]); and log-IgE level was associated with a decreased risk of small airway obstruction (0.403 [0.216–0.754]). Smoking status stratified analysis showed an association between log-IgE level and a decreased risk of small airway obstruction only in never-smoker asthmatics (0.487 [0.249–0.954]). Conclusions Current-smoking status and total serum IgE are, respectively, associated with small airway obstruction. Smoking status modifies the relationship between Th2 biomarkers and small airway function. These findings contribute to the understanding of risk factors associated with asthma endotyping.
Highlights
Asthma is a highly complex disease with unclear endotypes
We aim to investigate the relationship between 2 biomarkers, namely, blood eosinophil counts and serum IgE level, and small airway obstruction based on FEF25–75%pred measurements
A total of 478 subjects were selected for final analyses, when we excluded subjects if they had no records of FEF25–75% pred, blood eosinophil count, total serum IgE level, or smoking status (Supplementary Figure 1)
Summary
Asthma is a highly complex disease with unclear endotypes. It is known that 2 response promotes development of asthma [1]. Eosinophil counts and IgE level in blood are widely accepted as reliable 2 biomarkers in asthma diagnosis and management [2, 3]. 2-type cytokine gene polymorphisms are related with FEF25–75 value in asthma patients [7], suggesting that 2 response may promote small airway obstruction. We aim to investigate the relationship between 2 biomarkers, namely, blood eosinophil counts and serum IgE level, and small airway obstruction based on FEF25–75%pred measurements. Total serum IgE level and blood eosinophil count were used as biomarkers of the 2 phenotype. Smoking status stratified analysis showed an association between log-IgE level and a decreased risk of small airway obstruction only in never-smoker asthmatics (0.487 [0.249–0.954]). Current-smoking status and total serum IgE are, respectively, associated with small airway obstruction. Smoking status modifies the relationship between 2 biomarkers and small airway function. ese findings contribute to the understanding of risk factors associated with asthma endotyping
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