嗜酸性粒细胞增多症
医学
痰
呼出气一氧化氮
哮喘
骨膜炎
生物标志物
内科学
嗜酸性粒细胞
胃肠病学
曲线下面积
接收机工作特性
免疫学
病理
肺活量测定
肺结核
生物化学
化学
细胞外基质
生物
细胞生物学
作者
Ronina Covar,Stephen C. Lazarus,Jerry A. Krishnan,Kathryn Blake,Christine A. Sorkness,Anne‐Marie Dyer,Jason E. Lang,Njira Lugogo,David T. Mauger,Michael E. Wechsler,Sally E. Wenzel,Juan Carlos Cardet,Mario Castro,Elliot Israel,Wanda Phipatanakul,Tonya S. King
标识
DOI:10.1016/j.jaip.2023.12.010
摘要
Background
A multicenter clinical trial in patients with mild persistent asthma indicated that response to inhaled corticosteroids (ICS) is limited to those with sputum eosinophilia. However, testing for sputum eosinophilia is impractical in most clinical settings. Objective
We examined associations between sputum eosinophilia and type 2 inflammatory biomarkers in untreated mild persistent asthma. Methods
Induced sputum, blood eosinophil count (BEC), fractional exhaled nitric oxide (FeNO), and serum periostin were obtained twice during the 6-week run-in period in a clinical trial that enrolled patients 12 years and older with symptomatic, mild persistent asthma without controller therapy. The optimal threshold for each biomarker was based on achieving 80% or greater sensitivity. Performance of biomarkers (area under the receiver operating characteristics curve [AUC], range 0.0–1.0) in predicting sputum eosinophilia 2% or greater was determined; AUCs of 0.8 to 0.9 and more than 0.9 define excellent and outstanding discrimination, respectively. Results
Of 564 participants, 27% were sputum eosinophilic, 83% were atopic, 70% had BEC of 200/uL or higher or FeNO of 25 ppb or greater; 64% of participants without sputum eosinophilia had elevated BEC or FeNO. The AUCs for BEC, FeNO, and both together in predicting sputum eosinophilia were all below the threshold for excellent discrimination (AUC 0.75, 0.78, and 0.79, respectively). Periostin (in adults) had poor discrimination (AUC 0.59; P = .02). Conclusions
In untreated mild persistent asthma, there is substantial discordance between sputum eosinophilia, BEC, and FeNO. Until prospective trials test the ability of alternative biomarkers to predict ICS response, BEC or FeNO phenotyping may be an option to consider ICS through a shared decision-making process with consideration of other clinical features.
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