Treatment responsiveness of phenotypes of symptomatic airways obstruction in adults

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• 作者：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 ; ^{richard.beasley@mrinz.ac.nz" class="auth_mail" title="E-mail the corresponding author} ; for the New Zealand Respiratory Health Survey Study GroupJames 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
• 关键词：Phenotype ; asthma ; chronic obstructive pulmonary disease ; inhaled corticosteroid ; bronchodilator
• 刊名：Journal of Allergy and Clinical Immunology
• 出版年：2015
• 出版时间：September 2015
• 年：2015
• 卷：136
• 期：3
• 页码：601-609
• 全文大小：527 K

文摘

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 尾-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.