Type 2 biomarkers and prediction of future exacerbations and lung function decline in adult asthma

Publication date: Available online 30 March 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Ruth Semprini, Mathew Williams, Alex Semprini, Alice McDouall, James Fingleton, Cecile Holweg, Mark Weatherall, Richard Beasley, Irene Braithwaite
BackgroundType 2 biomarkers that predict both likelihood of future severe exacerbations and response to monoclonal antibody therapy in asthma, would be useful clinically in identifying patients both at greater risk of hospitalization, and most likely to benefit from monoclonal antibody therapy.ObjectiveTo describe the association between the Type 2 biomarkers, blood eosinophils, FeNO, serum periostin, serum IgE and time to severe exacerbation in a broad asthma population.MethodsParticipants from two adult asthma cohorts with baseline measurements of blood eosinophils, FeNO, serum periostin and serum IgE were reviewed after at least 12 months to obtain an exacerbation history, corroborated with general practitioner and hospital medical records. The association between baseline Type 2 biomarkers and time to exacerbation was described by Cox Proportional Hazard Ratios (HR) using multivariate models.Results212 participants were followed for a median (range) 3.8 (1.1 to 5.3) years. 67/212 (32%) had at least one severe exacerbation. The HR (95% CI) of baseline Type 2 biomarkers and time to exacerbation were: blood eosinophils per 0.1x10⁹/L increase 0.89 (0.76-1.05), P=0.17; log FeNO per 0.693 increase 0.65 (0.52-0.81), P<0.001; log serum periostin per 0.693 increase 0.62 (0.35-1.09), P=0.10; log serum IgE per 0.693 increase 0.89 (0.80-1.00), P=0.05.ConclusionThe positive association between Type 2 biomarkers and risk of severe exacerbations in populations with severe refractory asthma does not extend to mild and moderate asthma. Non-Type 2 asthma may represent a phenotype associated with an increased risk of severe exacerbations in a broad asthma population.