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Clinical evaluation of type 2 disease status in a real-world population of difficult to manage asthma using historic Electronic Health Care Records of Blood Eosinophil counts

Clinical evaluation of type 2 disease status in a real-world population of difficult to manage asthma using historic Electronic Health Care Records of Blood Eosinophil counts
Clinical evaluation of type 2 disease status in a real-world population of difficult to manage asthma using historic Electronic Health Care Records of Blood Eosinophil counts

Background: blood eosinophil measurement is essential for the phenotypic characterization of patients with difficult asthma and in determining eligibility for anti-IL-5/IL-5Rα biological therapies. However, assessing such measures over limited time spans may not reveal the true underlying eosinophilic phenotype, as treatment, including daily oral corticosteroid therapy, suppresses eosinophilic inflammation and asthma is intrinsically variable.

Methods: we interrogated the electronic healthcare records of patients in the Wessex AsThma CoHort of difficult asthma (WATCH) study (UK). In 501 patients being evaluated in this tertiary care centre for difficult to control asthma, all requested full blood count test results in a 10-year retrospective period from the index WATCH assessment were investigated (n = 11,176).

Results: in 235 biological therapy-naïve participants who had 10 or more measures in this time period, 40.3% were eosinophilic (blood eosinophils ≥300 cells/µl) at WATCH enrolment whilst an additional 43.1%, though not eosinophilic at enrolment, demonstrated eosinophilia at least once in the preceding decade. Persistent eosinophilia was associated with worse post-bronchodilator airway obstruction and higher Fractional exhaled Nitric Oxide (FeNO). In contrast, the 16.6% of patients who never demonstrated eosinophilia at this blood eosinophil threshold showed preserved lung function and lower markers of Type 2 inflammation.

Conclusions: this highlights the central role that type 2 inflammation, as indicated by blood eosinophilia, has in difficult asthma and suggests that longitudinal electronic healthcare record analysis can be an important tool in clinical asthma phenotyping, providing insight that may help understand disease progression and better guide more specific treatment approaches.

Asthma, T2 Asthma, eosinophils, phenotypes
0954-7894
811-820
Azim, Adnan
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Newell, Colin
fd859e4b-b3a6-4722-b1de-2e52c8633899
Barber, Clair
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Harvey, Matthew
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Knight, Deborah
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Freeman, Anna
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Fong, Wei Chern Gavin
dde77f6c-3b15-4d09-aadd-89985eaa3491
Dennison, Paddy
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Haitchi, Hans Michael
68dadb29-305d-4236-884f-e9c93f4d78fe
Djukanovic, Ratko
d9a45ee7-6a80-4d84-a0ed-10962660a98d
Kurukulaaratchy, Ramesh
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Howarth, Peter
ff19c8c4-86b0-4a88-8f76-b3d87f142a21
Azim, Adnan
87c31e0e-c9bf-4258-9ae9-889e2382e7ba
Newell, Colin
fd859e4b-b3a6-4722-b1de-2e52c8633899
Barber, Clair
ff31b460-34c3-466c-90e4-f70b3e954c82
Harvey, Matthew
d34fdc10-eecc-45be-aa7b-e2cd70318617
Knight, Deborah
4f44f912-5106-4fb5-9cf2-b4f86440523c
Freeman, Anna
3d83f907-e7ce-4649-a018-a7a31b19f934
Fong, Wei Chern Gavin
dde77f6c-3b15-4d09-aadd-89985eaa3491
Dennison, Paddy
30c232e3-c218-4dd8-979f-061ac70513d5
Haitchi, Hans Michael
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Djukanovic, Ratko
d9a45ee7-6a80-4d84-a0ed-10962660a98d
Kurukulaaratchy, Ramesh
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Howarth, Peter
ff19c8c4-86b0-4a88-8f76-b3d87f142a21

Azim, Adnan, Newell, Colin, Barber, Clair, Harvey, Matthew, Knight, Deborah, Freeman, Anna, Fong, Wei Chern Gavin, Dennison, Paddy, Haitchi, Hans Michael, Djukanovic, Ratko, Kurukulaaratchy, Ramesh and Howarth, Peter (2021) Clinical evaluation of type 2 disease status in a real-world population of difficult to manage asthma using historic Electronic Health Care Records of Blood Eosinophil counts. Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology, 51 (6), 811-820. (doi:10.1111/cea.13841).

Record type: Article

Abstract

Background: blood eosinophil measurement is essential for the phenotypic characterization of patients with difficult asthma and in determining eligibility for anti-IL-5/IL-5Rα biological therapies. However, assessing such measures over limited time spans may not reveal the true underlying eosinophilic phenotype, as treatment, including daily oral corticosteroid therapy, suppresses eosinophilic inflammation and asthma is intrinsically variable.

Methods: we interrogated the electronic healthcare records of patients in the Wessex AsThma CoHort of difficult asthma (WATCH) study (UK). In 501 patients being evaluated in this tertiary care centre for difficult to control asthma, all requested full blood count test results in a 10-year retrospective period from the index WATCH assessment were investigated (n = 11,176).

Results: in 235 biological therapy-naïve participants who had 10 or more measures in this time period, 40.3% were eosinophilic (blood eosinophils ≥300 cells/µl) at WATCH enrolment whilst an additional 43.1%, though not eosinophilic at enrolment, demonstrated eosinophilia at least once in the preceding decade. Persistent eosinophilia was associated with worse post-bronchodilator airway obstruction and higher Fractional exhaled Nitric Oxide (FeNO). In contrast, the 16.6% of patients who never demonstrated eosinophilia at this blood eosinophil threshold showed preserved lung function and lower markers of Type 2 inflammation.

Conclusions: this highlights the central role that type 2 inflammation, as indicated by blood eosinophilia, has in difficult asthma and suggests that longitudinal electronic healthcare record analysis can be an important tool in clinical asthma phenotyping, providing insight that may help understand disease progression and better guide more specific treatment approaches.

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More information

Accepted/In Press date: 22 January 2021
e-pub ahead of print date: 2 February 2021
Published date: 2 February 2021
Keywords: Asthma, T2 Asthma, eosinophils, phenotypes

Identifiers

Local EPrints ID: 446949
URI: http://eprints.soton.ac.uk/id/eprint/446949
ISSN: 0954-7894
PURE UUID: ca0d9514-33a6-4acb-a291-4849da79b06f
ORCID for Clair Barber: ORCID iD orcid.org/0000-0001-5335-5129
ORCID for Hans Michael Haitchi: ORCID iD orcid.org/0000-0001-8603-302X
ORCID for Ratko Djukanovic: ORCID iD orcid.org/0000-0001-6039-5612
ORCID for Ramesh Kurukulaaratchy: ORCID iD orcid.org/0000-0002-1588-2400

Catalogue record

Date deposited: 26 Feb 2021 17:33
Last modified: 23 Jul 2021 01:48

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Contributors

Author: Adnan Azim
Author: Colin Newell
Author: Clair Barber ORCID iD
Author: Matthew Harvey
Author: Deborah Knight
Author: Anna Freeman
Author: Wei Chern Gavin Fong
Author: Paddy Dennison
Author: Peter Howarth

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