Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute's Severe Asthma Research Program.

TitleCharacterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute's Severe Asthma Research Program.
Publication TypeJournal Article
Year of Publication2007
AuthorsMoore WC, Bleecker ER, Curran-Everett D, Erzurum SC, Ameredes BT, Bacharier L, Calhoun WJ, Castro M, Chung K F, Clark MP, Dweik RA, Fitzpatrick AM, Gaston B, Hew M, Hussain I, Jarjour NN, Israel E, Levy BD, Murphy JR, Peters SP, Teague GW, Meyers DA, Busse WW, Wenzel SE
Corporate AuthorsNational Heart, Lung, Blood Institute's Severe Asthma Research Program
JournalJ Allergy Clin Immunol
Volume119
Issue2
Pagination405-13
Date Published2007 Feb
ISSN0091-6749
KeywordsAdult, Age of Onset, Asthma, Delivery of Health Care, Female, Forced Expiratory Volume, Humans, Male, Middle Aged, Nitric Oxide, Phenotype, Severity of Illness Index, Skin Tests
Abstract

BACKGROUND: Severe asthma causes the majority of asthma morbidity. Understanding mechanisms that contribute to the development of severe disease is important.OBJECTIVE: The goal of the Severe Asthma Research Program is to identify and characterize subjects with severe asthma to understand pathophysiologic mechanisms in severe asthma.METHODS: We performed a comprehensive phenotypic characterization (questionnaires, atopy and pulmonary function testing, phlebotomy, exhaled nitric oxide) in subjects with severe and not severe asthma.RESULTS: A total of 438 subjects with asthma were studied (204 severe, 70 moderate, 164 mild). Severe subjects with asthma were older with longer disease duration (P < .0001), more daily symptoms, intense urgent health care utilization, sinusitis, and pneumonia (P < or = .0001). Lung function was lower in severe asthma with marked bronchodilator reversibility (P < .001). The severe group had less atopy by skin tests (P = .0007), but blood eosinophils, IgE, and exhaled nitric oxide levels did not differentiate disease severity. A reduced FEV(1), history of pneumonia, and fewer positive skin tests were risk factors for severe disease. Early disease onset (age < 12 years) in severe asthma was associated with longer disease duration (P < .0001) and more urgent health care, especially intensive care (P = .002). Later disease onset (age > or = 12 years) was associated with lower lung function and sinopulmonary infections (P < or = .02).CONCLUSION: Severe asthma is characterized by abnormal lung function that is responsive to bronchodilators, a history of sinopulmonary infections, persistent symptoms, and increased health care utilization.CLINICAL IMPLICATIONS: Lung function abnormalities in severe asthma are reversible in most patients, and pneumonia is a risk factor for the development of severe disease.

DOI10.1016/j.jaci.2006.11.639
Alternate JournalJ. Allergy Clin. Immunol.
PubMed ID17291857
PubMed Central IDPMC2837934
Grant ListHL69116 / HL / NHLBI NIH HHS / United States
HL69130 / HL / NHLBI NIH HHS / United States
HL69149 / HL / NHLBI NIH HHS / United States
HL69155 / HL / NHLBI NIH HHS / United States
HL69167 / HL / NHLBI NIH HHS / United States
HL69170 / HL / NHLBI NIH HHS / United States
HL69174 / HL / NHLBI NIH HHS / United States
HL69349 / HL / NHLBI NIH HHS / United States
M01 RR003186-22 / RR / NCRR NIH HHS / United States
M01 RR007122-14 / RR / NCRR NIH HHS / United States
M01 RR007122-14 / RR / NCRR NIH HHS / United States
M01 RR007122-17 / RR / NCRR NIH HHS / United States
M01 RR018390 / RR / NCRR NIH HHS / United States
M01 RR018390 / RR / NCRR NIH HHS / United States
M01 RR018390-03 / RR / NCRR NIH HHS / United States
M01 RR03186 / RR / NCRR NIH HHS / United States
R01 HL069116-09 / HL / NHLBI NIH HHS / United States
R01 HL069130-03 / HL / NHLBI NIH HHS / United States
R01 HL069149 / HL / NHLBI NIH HHS / United States
R01 HL069149-05 / HL / NHLBI NIH HHS / United States
R01 HL069155-05 / HL / NHLBI NIH HHS / United States
R01 HL069167-09 / HL / NHLBI NIH HHS / United States
R01 HL069170 / HL / NHLBI NIH HHS / United States
R01 HL069170-09 / HL / NHLBI NIH HHS / United States
R01 HL069174-09 / HL / NHLBI NIH HHS / United States
R01 HL069349-05 / HL / NHLBI NIH HHS / United States
UL1 RR024992-04 / RR / NCRR NIH HHS / United States

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