Dawei Wu1, Benjamin S Bleier2, Lun Li3, Xiaojun Zhan1, Lichuan Zhang1, Qianwen Lv1, Jianting Wang4, Yongxiang Wei5. 1. The Department of Otorhinolaryngology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China. 2. The Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Mass. 3. The Department of Respiratory Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China. 4. The Department of Otorhinolaryngology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, PR China. 5. The Department of Otorhinolaryngology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China. Electronic address: yongxw67@163.com.
Abstract
BACKGROUND: Nasal polyps and comorbid asthma (NPcA) is a common united airway disease and is highly heterogeneous with respect to clinical, physiologic, and pathologic parameters. The clinical phenotypes of NPcA are poorly understood. OBJECTIVE: We sought to explore clinical phenotypes in patients with NPcA. METHODS: Patients first diagnosed with NPcA were recruited from Rhinological Clinics and Respiratory Clinics. We clustered patients with NPcA based on parameters regarding natural courses and demographic characteristics. Patients were also evaluated with respect to clinical, functional, and inflammatory parameters in both upper and lower airways. RESULTS: Clustering of 110 cases resulted in 3 clusters: cluster 1 (n = 16, 14.55%, atopic NPcA) was predominantly atopic patients with child-onset airway symptoms, intermediate disease duration, history of family asthma, better lung function, and less severe asthma; cluster 2 (n = 32, 29.09%, smoking NPcA) was characterized by more smokers, short disease duration, adult-onset airway symptoms, less atopy, nonsteroidal anti-inflammatory drug sensitivity, prior sinus surgery history, eosinophilic airway phenotypes, worse lung function, and severe computed tomography appearance; and cluster 3 (n = 62, 56.36%, older NPcA) consisted mostly of older patients with long disease duration, adult-onset airway symptoms, less atopy, more noneosinophilic airway phenotypes, and prior sinus surgery history. CONCLUSIONS: Patients with NPcA with 3 distinct natural courses had different inflammatory status and disease severity. Determining the natural course of a patient might help clinicians predict the clinical aspects of NPcA and contribute to phenotype-guided management approaches in the future.
BACKGROUND: Nasal polyps and comorbid asthma (NPcA) is a common united airway disease and is highly heterogeneous with respect to clinical, physiologic, and pathologic parameters. The clinical phenotypes of NPcA are poorly understood. OBJECTIVE: We sought to explore clinical phenotypes in patients with NPcA. METHODS:Patients first diagnosed with NPcA were recruited from Rhinological Clinics and Respiratory Clinics. We clustered patients with NPcA based on parameters regarding natural courses and demographic characteristics. Patients were also evaluated with respect to clinical, functional, and inflammatory parameters in both upper and lower airways. RESULTS: Clustering of 110 cases resulted in 3 clusters: cluster 1 (n = 16, 14.55%, atopic NPcA) was predominantly atopicpatients with child-onset airway symptoms, intermediate disease duration, history of family asthma, better lung function, and less severe asthma; cluster 2 (n = 32, 29.09%, smoking NPcA) was characterized by more smokers, short disease duration, adult-onset airway symptoms, less atopy, nonsteroidal anti-inflammatory drug sensitivity, prior sinus surgery history, eosinophilic airway phenotypes, worse lung function, and severe computed tomography appearance; and cluster 3 (n = 62, 56.36%, older NPcA) consisted mostly of older patients with long disease duration, adult-onset airway symptoms, less atopy, more noneosinophilic airway phenotypes, and prior sinus surgery history. CONCLUSIONS:Patients with NPcA with 3 distinct natural courses had different inflammatory status and disease severity. Determining the natural course of a patient might help clinicians predict the clinical aspects of NPcA and contribute to phenotype-guided management approaches in the future.
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