- Title
- Clinical Subtypes of Neutrophilic Asthma: A Cluster Analysis From Australasian Severe Asthma Network
- Creator
- He, Li Xiu; Deng, Ke; Zhang, Li; Oliver, Brian G.; Wark, Peter A. B.; Qin, Ling; Gao, Peng; Wan, Hua Jing; Liu, Dan; Luo, Feng Ming; Li, Wei Min; Wang, Gang; Wang, Ji; Gibson, Peter Gerard; Zhang, Xin; Wang, Lei; Zhang, Hong Ping; Xie, Min; Chen, Zhi Hong; Zhang, Jie; Chen-Yu Hsu, Alan
- Relation
- Journal of Allergy and Clinical Immunology: In Practice Vol. 12, Issue 3, p. 686-698.e8
- Publisher Link
- http://dx.doi.org/10.1016/j.jaip.2023.09.023
- Publisher
- Elsevier
- Resource Type
- journal article
- Date
- 2024
- Description
- Background: Clinical heterogeneity may exist within asthma subtypes defined by inflammatory markers. However, the heterogeneity of neutrophilic asthma (NA) remains largely unexplored. Objective: To explore potential clusters and the stability of NA. Methods: Participants with NA from the Australasian Severe Asthma Network underwent a multidimensional assessment. They were then asked to participate in a 12-month longitudinal cohort study. We explored potential clusters using a hierarchical cluster analysis and validated the differential future risk of asthma exacerbations in the identified clusters. A decision tree analysis was developed to predict cluster assignments. Finally, the stability of prespecified clusters was examined within 1 month. Results: Three clusters were identified in 149 patients with NA. Cluster 1 (n = 99; 66.4%) was characterized by female-predominant nonsmokers with well-controlled NA, cluster 2 (n = 16; 10.7%) by individuals with comorbid anxiety/depressive symptoms with poorly controlled NA, and cluster 3 by older male smokers with late-onset NA. Cluster 2 had a greater proportion of participants with severe exacerbations (P =.005), hospitalization (P =.010), and unscheduled visits (P =.013) and a higher number of emergency room visits (P =.039) than that of the other two clusters. The decision tree assigned 92.6% of participants correctly. Most participants (87.5%; n = 7) in cluster 2 had a stable NA phenotype, whereas participants of clusters 1 and 3 had variable phenotypes. Conclusions: We identified three clinical clusters of NA, in which cluster 2 represents an uncontrolled and stable NA subtype with an elevated risk of exacerbations. These findings have clinical implications for the management of NA.
- Subject
- asthma; neutrophilic asthma; heterogeneity; phenotypes; cluster analysis; phenotype variability; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1500386
- Identifier
- uon:54912
- Identifier
- ISSN:2213-2198
- Language
- eng
- Reviewed
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