Persistence of eosinophilic asthma endotype and clinical outcomes: A real-world observational study

Trung N Tran; Marjan Kerkhof; Victoria Carter; David B. Price

doi:10.2147/JAA.S306416

Persistence of eosinophilic asthma endotype and clinical outcomes: A real-world observational study

Trung N Tran^* (Corresponding Author), Marjan Kerkhof, Victoria Carter, David B. Price

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

Abstract

Purpose:
Eosinophil count elevations are predictive of adverse outcomes in patients with asthma, yet little is known regarding longitudinal eosinophil patterns and their association with clinical outcomes. The goal of this study was to assess associations between longitudinal persistence of eosinophil elevations and both clinical outcomes and health care resource utilization (HCRU).Methods: Data were extracted from 2 databases in the United Kingdom. Patients included were aged ≥13 years, had active asthma, and had ≥3 blood eosinophil count (BEC) recordings. Patients were categorized by BEC as: never high (all BEC ≤300 cells/µL), intermittently high (≥1 BEC >300 cells/µL but <75% of BEC >300 cells/µL), or persistently high (≥75% of BEC 33 >300 cells/µL). Asthma exacerbations, asthma control (risk domain, overall, and full), and HCRU were evaluated for 12 months after the last BEC.
Results:
The study population comprised 148,021 patients. Persistently high, intermittently high, and never high eosinophil patterns were detected in 13.6%, 40.5%, and 45.9% of patients, respectively. Patients with ≥1 elevated BEC were at greater risk for severe asthma exacerbations, regardless of whether the elevation was persistent (rate ratio [RR]: 1.28 [95% CI 1.24-1.33]; P < .001) or intermittent (RR: 1.24 [95% CI 1.21-1.27]; P < .001), compared with patients with no eosinophil elevations. Full asthma control was achieved by <25% of patients across eosinophil pattern groups, and HCRU did not appreciably differ, although patients with persistently high BEC had the shortest hospital stay duration among the groups.
Conclusion:
These data suggest that elevated blood eosinophils, regardless of persistency, signify increased risk of severe asthma exacerbations.

Original language	English
Pages (from-to)	727-742
Number of pages	16
Journal	Journal of Asthma and Allergy
Volume	2021
Issue number	14
Early online date	25 Jun 2021
DOIs	https://doi.org/10.2147/JAA.S306416
Publication status	Published - 25 Jun 2021

Keywords

Asthma control
asthma exacerbation
biomarker
eosinophilia
phenotype
type 2 inflammation

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title = "Persistence of eosinophilic asthma endotype and clinical outcomes: A real-world observational study",

abstract = "Purpose: Eosinophil count elevations are predictive of adverse outcomes in patients with asthma, yet little is known regarding longitudinal eosinophil patterns and their association with clinical outcomes. The goal of this study was to assess associations between longitudinal persistence of eosinophil elevations and both clinical outcomes and health care resource utilization (HCRU).Methods: Data were extracted from 2 databases in the United Kingdom. Patients included were aged ≥13 years, had active asthma, and had ≥3 blood eosinophil count (BEC) recordings. Patients were categorized by BEC as: never high (all BEC ≤300 cells/µL), intermittently high (≥1 BEC >300 cells/µL but <75% of BEC >300 cells/µL), or persistently high (≥75% of BEC 33 >300 cells/µL). Asthma exacerbations, asthma control (risk domain, overall, and full), and HCRU were evaluated for 12 months after the last BEC.Results: The study population comprised 148,021 patients. Persistently high, intermittently high, and never high eosinophil patterns were detected in 13.6%, 40.5%, and 45.9% of patients, respectively. Patients with ≥1 elevated BEC were at greater risk for severe asthma exacerbations, regardless of whether the elevation was persistent (rate ratio [RR]: 1.28 [95% CI 1.24-1.33]; P < .001) or intermittent (RR: 1.24 [95% CI 1.21-1.27]; P < .001), compared with patients with no eosinophil elevations. Full asthma control was achieved by <25% of patients across eosinophil pattern groups, and HCRU did not appreciably differ, although patients with persistently high BEC had the shortest hospital stay duration among the groups.Conclusion: These data suggest that elevated blood eosinophils, regardless of persistency, signify increased risk of severe asthma exacerbations.",

keywords = "Asthma control, asthma exacerbation, biomarker, eosinophilia, phenotype, type 2 inflammation",

author = "Tran, {Trung N} and Marjan Kerkhof and Victoria Carter and Price, {David B.}",

note = "Acknowledgments Writing and editing support, including preparation of the draft manuscript under the direction and guidance of the authors, incorporating author feedback, and manuscript submission, was provided by Crystal Murcia, PhD (CiTRUS Healthcare Communications Group). This support was funded by AstraZeneca (Gaithersburg, Maryland). Funding This work was supported by AstraZeneca. A named author is an employee of AstraZeneca; therefore, AstraZeneca was involved in the study design; collection, analysis, and interpretation of data; and the development and review of the manuscript. The decision to submit the manuscript for publication was made by the authors.",

year = "2021",

month = jun,

day = "25",

doi = "10.2147/JAA.S306416",

language = "English",

volume = "2021",

pages = "727--742",

journal = "Journal of Asthma and Allergy",

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number = "14",

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TY - JOUR

T1 - Persistence of eosinophilic asthma endotype and clinical outcomes

T2 - A real-world observational study

AU - Tran, Trung N

AU - Kerkhof, Marjan

AU - Carter, Victoria

AU - Price, David B.

N1 - Acknowledgments Writing and editing support, including preparation of the draft manuscript under the direction and guidance of the authors, incorporating author feedback, and manuscript submission, was provided by Crystal Murcia, PhD (CiTRUS Healthcare Communications Group). This support was funded by AstraZeneca (Gaithersburg, Maryland). Funding This work was supported by AstraZeneca. A named author is an employee of AstraZeneca; therefore, AstraZeneca was involved in the study design; collection, analysis, and interpretation of data; and the development and review of the manuscript. The decision to submit the manuscript for publication was made by the authors.

PY - 2021/6/25

Y1 - 2021/6/25

N2 - Purpose: Eosinophil count elevations are predictive of adverse outcomes in patients with asthma, yet little is known regarding longitudinal eosinophil patterns and their association with clinical outcomes. The goal of this study was to assess associations between longitudinal persistence of eosinophil elevations and both clinical outcomes and health care resource utilization (HCRU).Methods: Data were extracted from 2 databases in the United Kingdom. Patients included were aged ≥13 years, had active asthma, and had ≥3 blood eosinophil count (BEC) recordings. Patients were categorized by BEC as: never high (all BEC ≤300 cells/µL), intermittently high (≥1 BEC >300 cells/µL but <75% of BEC >300 cells/µL), or persistently high (≥75% of BEC 33 >300 cells/µL). Asthma exacerbations, asthma control (risk domain, overall, and full), and HCRU were evaluated for 12 months after the last BEC.Results: The study population comprised 148,021 patients. Persistently high, intermittently high, and never high eosinophil patterns were detected in 13.6%, 40.5%, and 45.9% of patients, respectively. Patients with ≥1 elevated BEC were at greater risk for severe asthma exacerbations, regardless of whether the elevation was persistent (rate ratio [RR]: 1.28 [95% CI 1.24-1.33]; P < .001) or intermittent (RR: 1.24 [95% CI 1.21-1.27]; P < .001), compared with patients with no eosinophil elevations. Full asthma control was achieved by <25% of patients across eosinophil pattern groups, and HCRU did not appreciably differ, although patients with persistently high BEC had the shortest hospital stay duration among the groups.Conclusion: These data suggest that elevated blood eosinophils, regardless of persistency, signify increased risk of severe asthma exacerbations.

AB - Purpose: Eosinophil count elevations are predictive of adverse outcomes in patients with asthma, yet little is known regarding longitudinal eosinophil patterns and their association with clinical outcomes. The goal of this study was to assess associations between longitudinal persistence of eosinophil elevations and both clinical outcomes and health care resource utilization (HCRU).Methods: Data were extracted from 2 databases in the United Kingdom. Patients included were aged ≥13 years, had active asthma, and had ≥3 blood eosinophil count (BEC) recordings. Patients were categorized by BEC as: never high (all BEC ≤300 cells/µL), intermittently high (≥1 BEC >300 cells/µL but <75% of BEC >300 cells/µL), or persistently high (≥75% of BEC 33 >300 cells/µL). Asthma exacerbations, asthma control (risk domain, overall, and full), and HCRU were evaluated for 12 months after the last BEC.Results: The study population comprised 148,021 patients. Persistently high, intermittently high, and never high eosinophil patterns were detected in 13.6%, 40.5%, and 45.9% of patients, respectively. Patients with ≥1 elevated BEC were at greater risk for severe asthma exacerbations, regardless of whether the elevation was persistent (rate ratio [RR]: 1.28 [95% CI 1.24-1.33]; P < .001) or intermittent (RR: 1.24 [95% CI 1.21-1.27]; P < .001), compared with patients with no eosinophil elevations. Full asthma control was achieved by <25% of patients across eosinophil pattern groups, and HCRU did not appreciably differ, although patients with persistently high BEC had the shortest hospital stay duration among the groups.Conclusion: These data suggest that elevated blood eosinophils, regardless of persistency, signify increased risk of severe asthma exacerbations.

KW - Asthma control

KW - asthma exacerbation

KW - biomarker

KW - eosinophilia

KW - phenotype

KW - type 2 inflammation

U2 - 10.2147/JAA.S306416

DO - 10.2147/JAA.S306416

M3 - Article

VL - 2021

SP - 727

EP - 742

JO - Journal of Asthma and Allergy

JF - Journal of Asthma and Allergy

SN - 1178-6965

IS - 14

ER -

Persistence of eosinophilic asthma endotype and clinical outcomes: A real-world observational study

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Keywords

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