Elsevier

Respiratory Medicine

Volume 143, October 2018, Pages 31-38
Respiratory Medicine

Disconnect of type 2 biomarkers in severe asthma; dominated by FeNO as a predictor of exacerbations and periostin as predictor of reduced lung function

https://doi.org/10.1016/j.rmed.2018.08.005Get rights and content
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Highlights

  • The relations of T2 biomarkers to asthma outcomes in severe asthma remain uncertain.

  • Exacerbations markers dominated by FeNO and lung function dominated by periostin.

  • Our findings define further the T2 biomarkers utility in severe asthma clinics.

Abstract

Background

biomarkers of Type 2 (T2) inflammation may predict asthma control and exacerbation risk. However, the relationships between individual T2 biomarkers to exacerbations and lung function in severe asthma remain uncertain.

Objectives

to explore the roles played by T2 biomarkers individually and as a composite score in predicting clinical outcomes in severe asthma.

Methods

unselected severe asthma patients were enrolled in this cross sectional real life study. Participants were clinically characterised and the following measurements were obtained: the frequency of exacerbations requiring oral corticosteroids (OCS), asthma control (Juniper ACQ6-7), lung function, Fraction exhaled Nitric Oxide (FeNO), peripheral blood eosinophils (PBE), and serum periostin.

Results

A total of 115 patients were recruited [mean age 45 years (range 18–70), 80 (69.6%) females, mean forced expiratory volume in first second (FEV1) %predicted was 68% ± 24.7, mean inhaled corticosteroids (ICS) 1.96 ± 0.82 mg/day. FeNO correlated significantly with PBE (r = 0.35, p = 0.0004), but not with periostin (r = 0.22, p = 0.065) and there was no significant correlation between PBE and periostin. FeNO correlation with exacerbations (r = 0.42, p = 0.0008) was stronger than PBE and periostin. A composite score of the 3 biomarkers correlated with exacerbations in a dose-dependent manner but multiple regression analysis did not confirm an added benefit. Only periostin demonstrated a significant correlation with FEV1%predicted (r = −0.34, p = 0.004) with ROC-AUC 0.7.

Conclusion

FeNO demonstrated stronger correlation with asthma exacerbations than PBE or periostin with no definite added benefit from a composite score of the 3 biomarkers. Only periostin showed significant association with reduced lung function raising its potential as a biomarker of airway remodeling.

Keywords

Severe asthma
Type 2 inflammation
FeNO
Blood eosinophils
Periostin
Lung function
Exacerbations
Asthma control

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