Treatable Traits in Elderly Asthmatics from the Australasian Severe Asthma Network: A Prospective Cohort Study

Wen Wen Wu; Xin Zhang; Min Li; Ying Liu; Zhi Hong Chen; Min Xie; Shu Zhen Zhao; Gang Wang; Hong Ping Zhang; Ting Wang; Ling Qin; Lei Wang; Brian G Oliver; Hua Jing Wan; Jie Zhang; Vanessa M McDonald; Guy B Marks; Wei Min Li; Surinder S Birring; Gang Wang; Peter G Gibson

doi:10.1016/j.jaip.2021.03.042

Treatable Traits in Elderly Asthmatics from the Australasian Severe Asthma Network: A Prospective Cohort Study

J Allergy Clin Immunol Pract. 2021 Jul;9(7):2770-2782. doi: 10.1016/j.jaip.2021.03.042. Epub 2021 Apr 5.

Authors

Wen Wen Wu¹, Xin Zhang¹, Min Li², Ying Liu¹, Zhi Hong Chen³, Min Xie⁴, Shu Zhen Zhao⁵, Gang Wang⁶, Hong Ping Zhang⁷, Ting Wang⁸, Ling Qin⁹, Lei Wang⁷, Brian G Oliver¹⁰, Hua Jing Wan², Jie Zhang¹¹, Vanessa M McDonald¹², Guy B Marks¹³, Wei Min Li¹⁴, Surinder S Birring¹⁵, Gang Wang¹⁶, Peter G Gibson¹²

Affiliations

¹ Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, Sichuan, China.
² Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, Sichuan, China.
³ Shanghai Institute of Respiratory Disease, Respiratory Division of Zhongshan Hospital, Fudan University, Shanghai, China.
⁴ Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Science & Technology, Wuhan, China.
⁵ Outpatient Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
⁶ Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, Sichuan, China; West China School of Medicine, Sichuan University, Chengdu, China; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
⁷ Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, Sichuan, China.
⁸ Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
⁹ Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China.
¹⁰ School of Life Sciences, University of Technology Sydney, Ultimo, NSW, Australia; Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.
¹¹ Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China.
¹² Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.
¹³ Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.
¹⁴ Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Respiratory Microbiome Laboratory, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, Sichuan, China.
¹⁵ Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.
¹⁶ Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, Sichuan, China. Electronic address: wcums-respiration@hotmail.com.

PMID: 33831621
DOI: 10.1016/j.jaip.2021.03.042

Abstract

Background: Data on treatable traits (TTs) in different populations are limited.

Objective: To assess TTs in elderly patients with asthma and compare them to younger patients, to evaluate the association of TTs with future exacerbations, and to develop an exacerbation prediction model.

Methods: We consecutively recruited 521 participants at West China Hospital, Sichuan University based on the Australasian Severe Asthma Network, classified as elderly (n = 62) and nonelderly (n = 459). Participants underwent a multidimensional assessment to characterize the TTs and were then followed up for 12 months. TTs and their relationship with future exacerbations were described. Based on the TTs and asthma control levels, an exacerbation prediction model was developed, and the overall performance was externally validated in an independent cohort.

Results: A total of 38 TTs were assessed. Elderly patients with asthma had more chronic metabolic diseases, fixed airflow limitation, emphysema, and neutrophilic inflammation, whereas nonelderly patients with asthma exhibited more allergic characteristics and psychiatric diseases. Nine traits were associated with increased future exacerbations, of which exacerbation prone, upper respiratory infection-induced asthma attack, cardiovascular disease, diabetes, and depression were the strongest. A model including exacerbation prone, psychiatric disease, cardiovascular disease, upper respiratory infection-induced asthma attack, noneosinophilic inflammation, cachexia, food allergy, and asthma control was developed to predict exacerbation risk and showed good performance.

Conclusions: TTs can be systematically assessed in elderly patients with asthma, some of which are associated with future exacerbations, proving their clinical utility of evaluating them. A model based on TTs can be used to predict exacerbation risk in people with asthma.

Keywords: Asthma; Elderly; Exacerbation; Prediction model; The Australasian Severe Asthma Network; Treatable traits.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Asthma* / epidemiology
China
Disease Progression
Humans
Hypersensitivity*
Lung
Prospective Studies