S'abonner

Treatment responsiveness of phenotypes of symptomatic airways obstruction in adults - 04/09/15

Doi : 10.1016/j.jaci.2015.01.013 
James Fingleton, PhD a, b, c, Justin Travers, MBChB a, d, Mathew Williams, Dip Ex Sci a, Thomas Charles, DipSM a, Darren Bowles, MBChB a, b, Rianne Strik, BSc a, Philippa Shirtcliffe, MBChB a, b, Mark Weatherall, MBChB b, e, Richard Beasley, DSc a, b, c,
for the

New Zealand Respiratory Health Survey Study Group

James Fingleton : clinical coordinating investigator, Justin Travers, Mark Weatherall : study biostatistician, Richard Beasley : principal investigator, Mathew Williams, Philippa Shirtcliffe : designated safety reviewer, Thomas Charles, Darren Bowles, Irene Braithwaite, Rianne Strik, Natalie Dooney, Tanya Baker, Mitesh Patel, Mark Holliday, Maureen Stretch, Alison Pritchard, Denise Fabian, Claire Munro, Alexander Hosking, Alex Brinded, Gordon Purdie

a Medical Research Institute of New Zealand, Wellington, New Zealand 
b Capital & Coast District Health Board, Wellington, New Zealand 
c Victoria University of Wellington, Wellington, New Zealand 
d Hutt Valley District Health Board, Lower Hutt, New Zealand 
e University of Otago Wellington, Wellington, New Zealand 

Corresponding author: Richard Beasley, DSc, Medical Research Institute of New Zealand, Private Bag 7902, Wellington 6242, New Zealand.

Abstract

Background

Asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous disorders encompassing different phenotypes of airflow obstruction, which might differ in their response to treatment.

Objective

The aim of this study was to determine distinct phenotypes comprising the syndromes of asthma and COPD and the treatment responsiveness of these phenotypes to inhaled β-agonist, antimuscarinic, and corticosteroid therapy.

Methods

We undertook a cross-sectional study with 3 phases. In phase 1, 1,264 participants aged 18 to 75 years with self-reported current wheeze and breathlessness were identified from a random population sample of 16,459. In phase 2, 451 participants attended for detailed assessment, including responsiveness to inhaled salbutamol and ipratropium bromide. In phase 3, 168 steroid-naive participants were enrolled in a 12-week trial of inhaled budesonide. Cluster analysis was performed in 389 participants who completed phase 2 with full data. Treatment responsiveness was compared between phenotypes.

Results

Cluster analysis identified 5 phenotypes: moderate-to-severe childhood-onset atopic asthma, asthma-COPD overlap, obese-comorbid, mild childhood-onset atopic asthma, and mild intermittent. Bronchodilation after salbutamol was equal to or greater than that after ipratropium for all phenotypes. The moderate-to-severe childhood-onset atopic asthma, asthma-COPD overlap, and obese-comorbid phenotypes had greater efficacy with inhaled corticosteroid treatment than the mild intermittent group.

Conclusion

Cluster analysis of adults with symptomatic airflow obstruction identifies 5 disease phenotypes, including asthma-COPD overlap and obese-comorbid phenotypes, and provides evidence that patients with the asthma-COPD overlap syndrome might benefit from inhaled corticosteroid therapy.

Le texte complet de cet article est disponible en PDF.

Key words : Phenotype, asthma, chronic obstructive pulmonary disease, inhaled corticosteroid, bronchodilator

Abbreviations used : ACOS, ACQ, ATS, COPD, Feno, hsCRP, ICS, SGRQ


Plan


 The primary funder of the study was the Health Research Council of New Zealand (grant no. 10/174). Additional research funding was provided by AstraZeneca AB, Sweden; AstraZeneca Limited, New Zealand; and Genentech.
 Disclosure of potential conflict of interest: D. Bowles is employed by the Medical Research Institute of New Zealand, which has received funding from the HRC of New Zealand, and has received travel support from Boehringer Ingelheim. R. Beasley has received personal fees from GlaxoSmithKline, Cytos Biotechnology, Pharmaxis, Novartis, AstraZeneca, Boehringer Ingelheim, Nycomed, and Otsuka Pharmaceuticals and he has received grants from Novartis, AstraZeneca, Cephalon, Chiesi, and Genentech. The rest of the authors declare that they have no relevant conflicts of interest.
 Australian New Zealand Clinical Trials Registry no. ACTRN12610000666022.


© 2015  American Academy of Allergy, Asthma & Immunology. Publié par Elsevier Masson SAS. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

  • Contenu

Vol 136 - N° 3

P. 601-609 - septembre 2015 Retour au numéro
Article précédent Article précédent
  • Comparison of asthma prevalence among African American teenage youth attending public high schools in rural Georgia and urban Detroit
  • Dennis R. Ownby, Martha S. Tingen, Suzanne Havstad, Jennifer L. Waller, Christine C. Johnson, Christine L.M. Joseph
| Article suivant Article suivant
  • The effect of geographic access on severe health outcomes for pediatric asthma
  • Erin Garcia, Nicoleta Serban, Julie Swann, Anne Fitzpatrick

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

Mon compte


Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.


Tout le contenu de ce site: Copyright © 2024 Elsevier, ses concédants de licence et ses contributeurs. Tout les droits sont réservés, y compris ceux relatifs à l'exploration de textes et de données, a la formation en IA et aux technologies similaires. Pour tout contenu en libre accès, les conditions de licence Creative Commons s'appliquent.