K Sekiya1,2, E Nakatani3, Y Fukutomi1, H Kaneda3, M Iikura4, M Yoshida5, K Takahashi6, K Tomii7, M Nishikawa8, N Kaneko9, Y Sugino10, M Shinkai11, T Ueda12, Y Tanikawa13, T Shirai14, M Hirabayashi15, T Aoki16, T Kato17, K Iizuka18, S Homma2, M Taniguchi1, H Tanaka19. 1. Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan. 2. Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan. 3. Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan. 4. Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan. 5. Department of Internal Medicine, National Hospital Organization Fukuoka Hospital, Fukuoka, Japan. 6. Department of Respiratory Diseases and Chest Surgery, Otsu Red Cross Hospital, Otsu, Japan. 7. Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan. 8. Department of Respiratory Medicine, Fujisawa City Hospital, Fujisawa, Japan. 9. Department of Pulmonary Medicine, Kameda Medical Center, Kamogawa, Japan. 10. Department of Respiratory Medicine, Toyota Memorial Hospital, Toyota, Japan. 11. Respiratory Disease Center, Yokohama City University Medical Center, Yokohama, Japan. 12. The Department of Respiratory Medicine, Saiseikai Nakatsu Hospital, Osaka, Japan. 13. Department of Respiratory Medicine and Clinical Immunology, Toyota Kosei Hospital, Toyota, Japan. 14. Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan. 15. Department of Respiratory Diseases, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan. 16. Department of Internal Medicine, Respiratory Division, Tokai University School of Medicine, Isehara, Japan. 17. Department of Respiratory Medicine and Allergology, Kariya Toyota General Hospital, Kariya, Japan. 18. Internal Medicine, Public Tomioka General Hospital, Tomioka, Japan. 19. NPO Sapporo Cough Asthma and Allergy Center, Sapporo, Japan.
Abstract
BACKGROUND: Severe or life-threatening asthma exacerbation is one of the worst outcomes of asthma because of the risk of death. To date, few studies have explored the potential heterogeneity of this condition. OBJECTIVES: To examine the clinical characteristics and heterogeneity of patients with severe or life-threatening asthma exacerbation. METHODS: This was a multicentre, prospective study of patients with severe or life-threatening asthma exacerbation and pulse oxygen saturation < 90% who were admitted to 17 institutions across Japan. Cluster analysis was performed using variables from patient- and physician-orientated structured questionnaires. RESULTS: Analysis of data from 175 patients with severe or life-threatening asthma exacerbation revealed five distinct clusters. Cluster 1 (n = 27) was younger-onset asthma with severe symptoms at baseline, including limitation of activities, a higher frequency of treatment with oral corticosteroids and short-acting beta-agonists, and a higher frequency of asthma hospitalizations in the past year. Cluster 2 (n = 35) was predominantly composed of elderly females, with the highest frequency of comorbid, chronic hyperplastic rhinosinusitis/nasal polyposis, and a long disease duration. Cluster 3 (n = 40) was allergic asthma without inhaled corticosteroid use at baseline. Patients in this cluster had a higher frequency of atopy, including allergic rhinitis and furred pet hypersensitivity, and a better prognosis during hospitalization compared with the other clusters. Cluster 4 (n = 34) was characterized by elderly males with concomitant chronic obstructive pulmonary disease (COPD). Although cluster 5 (n = 39) had very mild symptoms at baseline according to the patient questionnaires, 41% had previously been hospitalized for asthma. CONCLUSIONS & CLINICAL RELEVANCE: This study demonstrated that significant heterogeneity exists among patients with severe or life-threatening asthma exacerbation. Differences were observed in the severity of asthma symptoms and use of inhaled corticosteroids at baseline, and the presence of comorbid COPD. These findings may contribute to a deeper understanding and better management of this patient population.
BACKGROUND: Severe or life-threatening asthma exacerbation is one of the worst outcomes of asthma because of the risk of death. To date, few studies have explored the potential heterogeneity of this condition. OBJECTIVES: To examine the clinical characteristics and heterogeneity of patients with severe or life-threatening asthma exacerbation. METHODS: This was a multicentre, prospective study of patients with severe or life-threatening asthma exacerbation and pulse oxygen saturation < 90% who were admitted to 17 institutions across Japan. Cluster analysis was performed using variables from patient- and physician-orientated structured questionnaires. RESULTS: Analysis of data from 175 patients with severe or life-threatening asthma exacerbation revealed five distinct clusters. Cluster 1 (n = 27) was younger-onset asthma with severe symptoms at baseline, including limitation of activities, a higher frequency of treatment with oral corticosteroids and short-acting beta-agonists, and a higher frequency of asthma hospitalizations in the past year. Cluster 2 (n = 35) was predominantly composed of elderly females, with the highest frequency of comorbid, chronic hyperplastic rhinosinusitis/nasal polyposis, and a long disease duration. Cluster 3 (n = 40) was allergic asthma without inhaled corticosteroid use at baseline. Patients in this cluster had a higher frequency of atopy, including allergic rhinitis and furred pet hypersensitivity, and a better prognosis during hospitalization compared with the other clusters. Cluster 4 (n = 34) was characterized by elderly males with concomitant chronic obstructive pulmonary disease (COPD). Although cluster 5 (n = 39) had very mild symptoms at baseline according to the patient questionnaires, 41% had previously been hospitalized for asthma. CONCLUSIONS & CLINICAL RELEVANCE: This study demonstrated that significant heterogeneity exists among patients with severe or life-threatening asthma exacerbation. Differences were observed in the severity of asthma symptoms and use of inhaled corticosteroids at baseline, and the presence of comorbid COPD. These findings may contribute to a deeper understanding and better management of this patient population.
Authors: H Tanaka; E Nakatani; Y Fukutomi; K Sekiya; H Kaneda; M Iikura; M Yoshida; K Takahashi; K Tomii; M Nishikawa; N Kaneko; Y Sugino; M Shinkai; T Ueda; Y Tanikawa; T Shirai; M Hirabayashi; T Aoki; T Kato; K Iizuka; M Fujii; M Taniguchi Journal: Allergy Date: 2017-12-19 Impact factor: 13.146