J Serrano-Pariente1, G Rodrigo2, J A Fiz3, A Crespo4, V Plaza4. 1. Pneumology Department, Hospital Comarcal d'Inca, Balearic Islands, Spain. 2. Emergency Department, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay. 3. Pneumology Department, Hospital Germans Trias i Pujol de Badalona (Barcelona), Institut de Bioingenieria de Catalunya (IBEC), Barcelona, Spain. 4. Pneumology Department, Hospital de la Santa Creu i de Sant Pau de Barcelona, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain.
Abstract
BACKGROUND: Near-fatal asthma (NFA) is a heterogeneous clinical entity and several profiles of patients have been described according to different clinical, pathophysiological and histological features. However, there are no previous studies that identify in a unbiased way--using statistical methods such as clusters analysis--different phenotypes of NFA. Therefore, the aim of the present study was to identify and to characterize phenotypes of near fatal asthma using a cluster analysis. METHODS: Over a period of 2 years, 33 Spanish hospitals enrolled 179 asthmatics admitted for an episode of NFA. A cluster analysis using two-steps algorithm was performed from data of 84 of these cases. RESULTS: The analysis defined three clusters of patients with NFA: cluster 1, the largest, including older patients with clinical and therapeutic criteria of severe asthma; cluster 2, with an high proportion of respiratory arrest (68%), impaired consciousness level (82%) and mechanical ventilation (93%); and cluster 3, which included younger patients, characterized by an insufficient anti-inflammatory treatment and frequent sensitization to Alternaria alternata and soybean. CONCLUSIONS: These results identify specific asthma phenotypes involved in NFA, confirming in part previous findings observed in studies with a clinical approach. The identification of patients with a specific NFA phenotype could suggest interventions to prevent future severe asthma exacerbations.
BACKGROUND: Near-fatal asthma (NFA) is a heterogeneous clinical entity and several profiles of patients have been described according to different clinical, pathophysiological and histological features. However, there are no previous studies that identify in a unbiased way--using statistical methods such as clusters analysis--different phenotypes of NFA. Therefore, the aim of the present study was to identify and to characterize phenotypes of near fatal asthma using a cluster analysis. METHODS: Over a period of 2 years, 33 Spanish hospitals enrolled 179 asthmatics admitted for an episode of NFA. A cluster analysis using two-steps algorithm was performed from data of 84 of these cases. RESULTS: The analysis defined three clusters of patients with NFA: cluster 1, the largest, including older patients with clinical and therapeutic criteria of severe asthma; cluster 2, with an high proportion of respiratory arrest (68%), impaired consciousness level (82%) and mechanical ventilation (93%); and cluster 3, which included younger patients, characterized by an insufficient anti-inflammatory treatment and frequent sensitization to Alternaria alternata and soybean. CONCLUSIONS: These results identify specific asthma phenotypes involved in NFA, confirming in part previous findings observed in studies with a clinical approach. The identification of patients with a specific NFA phenotype could suggest interventions to prevent future severe asthma exacerbations.
Authors: Andrea Vianello; Marco Caminati; Mariangiola Crivellaro; Rafi El Mazloum; Rossella Snenghi; Michele Schiappoli; Annarita Dama; Andrea Rossi; Giuliana Festi; Maria Rita Marchi; Chiara Bovo; Giorgio Walter Canonica; Gianenrico Senna Journal: World Allergy Organ J Date: 2016-12-14 Impact factor: 4.084
Authors: Joseph H Skalski; Jose J Limon; Purnima Sharma; Matthew D Gargus; Christopher Nguyen; Jie Tang; Ana Lucia Coelho; Cory M Hogaboam; Timothy R Crother; David M Underhill Journal: PLoS Pathog Date: 2018-09-20 Impact factor: 6.823