Reduced bronchodilator reversibility correlates with non-type 2 high asthma and future exacerbations: A prospective cohort study

Lei Liu; Xin Zhang; Li Zhang; Ying Liu; Hong Ping Zhang; Shu Zhen Zhao; Jie Zhang; Wei Jie Zhang; Fang Wang; Lei Wang; Anny Xiaobo Zhou; Wei Min Li; Gang Wang; Peter Gerard Gibson

doi:10.1016/j.rmed.2022.106924

Reduced bronchodilator reversibility correlates with non-type 2 high asthma and future exacerbations: A prospective cohort study

Respir Med. 2022 Aug-Sep:200:106924. doi: 10.1016/j.rmed.2022.106924. Epub 2022 Jun 23.

Authors

Lei Liu¹, Xin Zhang¹, Li Zhang¹, Ying Liu¹, Hong Ping Zhang², Shu Zhen Zhao³, Jie Zhang⁴, Wei Jie Zhang⁵, Fang Wang⁶, Lei Wang², Anny Xiaobo Zhou⁷, Wei Min Li⁸, Gang Wang⁹, Peter Gerard Gibson¹⁰

Affiliations

¹ Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, 610041, Sichuan, China.
² Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
³ Outpatient Department, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
⁴ Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Jilin University, Changchun 130041, Jilin, China.
⁵ Department of Respiratory Disease, Jilin Province People's Hospital, Changchun, 130021, Jilin, China.
⁶ Department of Pathogen Biology, Basic Medical College, Jilin University, Changchun, 130021, Jilin, China.
⁷ Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁸ Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China. Electronic address: weimin003@163.com.
⁹ Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, 610041, Sichuan, China. Electronic address: wcums-respiration@hotmail.com.
¹⁰ Priority Research Centre for Healthy Lungs and Centre of Excellence in Severe Asthma, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia.

PMID: 35772189
DOI: 10.1016/j.rmed.2022.106924

Abstract

Background: Given that airway obstruction in asthma is not always fully reversible, reduced bronchodilator reversibility (BDR) may be a special asthma phenotype.

Objective: To explore the characteristics of BDR^high/low phenotypes (defined using two BDR criteria) and their associations with asthma exacerbations (AEs).

Methods: After baseline assessments, all patients were classified into BDR^high or BDR^low phenotypes. This study consisted of 2 parts. Part I was a 12-month prospective observational cohort study designed to identify the clinical characteristics and associations with future AEs in BDR^high/low phenotypes (n = 456). Part II, designed as a post hoc analysis of the data obtained in Part I, was conducted to assess the association between BDR^high/low phenotypes and treatment responsiveness (n = 360).

Results: Subjects with BDR^low phenotypes had better baseline asthma symptom control and was negatively associated with eosinophilic asthma and type 2 (T2) high asthma. During the 12-month follow-up, those with BDR^low phenotypes had a higher risk of severe AEs (SAEs) (guideline-based criterion: RR_adj = 2.24, 95% CI = [1.25, 3.68]; Ward's criterion: RR_adj = 2.46, 95% CI = [1.40, 4.00]) and moderate-to-severe AEs (MSAEs) (guideline-based criterion: RR_adj = 1.83, 95% CI = [1.22, 2.56]; Ward's criterion: RR_adj = 1.94, 95% CI = [1.32, 2.68]) in the following year according to logistic regression models. Similar findings were obtained with negative binominal regression models. BDR^low phenotype was a risk factor for an insensitive response to anti-asthma treatment (guideline-based criterion: OR_adj = 1.96, 95% CI = [1.05, 3.65]; Ward's criterion: OR_adj = 2.01, 95% CI = [1.12, 3.58]).

Conclusion: We identified that BDR^low phenotype was associated with non-T2 high asthma and future AEs. These findings have clinically relevant implications for asthma management.

Keywords: Asthma; Bronchodilator reversibility; Exacerbations; Phenotypes.

Publication types

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

MeSH terms

Airway Obstruction* / drug therapy
Asthma* / diagnosis
Asthma* / drug therapy
Bronchodilator Agents / adverse effects
Forced Expiratory Volume
Humans
Prospective Studies

Substances

Bronchodilator Agents