Characteristics of eosinophilic severe asthmatics in the Wessex Severe Asthma Cohort (WSAC)

Jones, Thomas, Brown, Thomas, Elliott, Scott, Rupani, Hitasha, Chauhan, Anoop, Barber, Clair, Gove, Kerry, Lau, Laurie and Howarth, Peter (2017) Characteristics of eosinophilic severe asthmatics in the Wessex Severe Asthma Cohort (WSAC). European Respiratory Journal, 50 (Suppl 61), [PA4042].

Abstract

Background: Severe asthma is a complex amalgam of phenotypes and comorbidities. Most novel therapies target type 2 disease so determining the optimal treatment for each patient will likely require detailed phenotyping. The WSAC study recruited 491 participants split between severe asthma (n=342), mild asthma (n=69) and healthy controls (n=80) for detailed phenotyping; inclusion criteria were asthma diagnosed as per guidelines and at least 1 exacerbation in 12 months. Smokers and those with comorbidity were included in order to reflect clinical practice. We aimed to assess the differences in demographic and clinical characteristics between participants with eosinophilic and non-eosinophilic severe asthma in the WSAC.
Methods: WSAC participants with severe asthma (BTS Step 4-5) were included for analysis if they underwent successful sputum induction. Demographics, medication use, comorbidities, FEV1, FeNO, Asthma Control Questionnaire 6 (ACQ6) score and exacerbation frequency were compared between eosinophilic and non-eosinophilic groups.
Results: 210 participants provided sputum, of which 86 (41%) had sputum eosinophils over 3%. These participants were more likely to be male (52% vs 29%) and never smokers(59% vs 45%), had lower median FEV1(68% vs 77% predicted) and BMI(28.2 vs 31.8) but higher FeNO(32 vs 16ppb) and were less likely to use antidepressants(13% vs 27%) or reflux treatment(39% vs 55%) (all P<0.05). Annual exacerbation rate(3.2 vs 3.0), past Intensive Care Unit admission(18% vs 17%), ACQ6(2.7 vs 2.9) and ICS dose were not significantly different.
Conclusion: Severe asthmatics with sputum eosinophilia despite high-dose ICS have poorer lung function but less obesity, depression and reflux

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Contributors

Author: Clair Barber

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