Treatment responsiveness of phenotypes of symptomatic airways obstruction in adults

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:136

Article

Fingleton, James^1,2,3  Travers, Justin^1,4  Williams, Mathew¹  Charles, Thomas¹  Bowles, Darren^1,2  Strik, Rianne¹  Shirtcliffe, Philippa^1,2  Weatherall, Mark^2,5  Beasley, Richard^1,2,3 

[1] Med Res Inst New Zealand, Wellington 6242, New Zealand

[2] Capital & Coast Dist Hlth Board, Wellington, New Zealand

[3] Victoria Univ Wellington, Wellington, New Zealand

[4] Hutt Valley Dist Hlth Board, Lower Hutt, New Zealand

[5] Univ Otago Wellington, Wellington, New Zealand

关键词: Phenotype;    asthma;    chronic obstructive pulmonary disease;    inhaled corticosteroid;    bronchodilator;   

DOI  :  10.1016/j.jaci.2015.01.013

来源: Elsevier

【 摘 要 】

Background: Asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous disorders encompassing different phenotypes of airflow obstruction, which might differ in their response to treatment. Objective: The aim of this study was to determine distinct phenotypes comprising the syndromes of asthma and COPD and the treatment responsiveness of these phenotypes to inhaled beta-agonist, antimuscarinic, and corticosteroid therapy. Methods: We undertook a cross-sectional study with 3 phases. In phase 1, 1,264 participants aged 18 to 75 years with self-reported current wheeze and breathlessness were identified from a random population sample of 16,459. In phase 2, 451 participants attended for detailed assessment, including responsiveness to inhaled salbutamol and ipratropium bromide. In phase 3, 168 steroid-naive participants were enrolled in a 12-week trial of inhaled budesonide. Cluster analysis was performed in 389 participants who completed phase 2 with full data. Treatment responsiveness was compared between phenotypes. Results: Cluster analysis identified 5 phenotypes: moderate-to-severe childhood-onset atopic asthma, asthma-COPD overlap, obese-comorbid, mild childhood-onset atopic asthma, and mild intermittent. Bronchodilation after salbutamol was equal to or greater than that after ipratropium for all phenotypes. The moderate-to-severe childhood-onset atopic asthma, asthma-COPD overlap, and obese-comorbid phenotypes had greater efficacy with inhaled corticosteroid treatment than the mild intermittent group. Conclusion: Cluster analysis of adults with symptomatic airflow obstruction identifies 5 disease phenotypes, including asthma-COPD overlap and obese-comorbid phenotypes, and provides evidence that patients with the asthma-COPD overlap syndrome might benefit from inhaled corticosteroid therapy.

【 授权许可】

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