Type 2-High Severe Asthma with and without Bronchiectasis: A Prospective Observational Multicentre Study

Abstract

Introduction

Type 2-high severe asthma (T2-SA) is often associated with several comorbidities. To this extent, the coexistence of T2-SA and bronchiectasis (BE) is considered an emerging phenotype.

Methods

We performed a prospective observational multicentre study, including T2-SA patients. Chest HRCT confirmed the presence of BE. Data on exacerbations, pulmonary function, Asthma Control Test (ACT), chronic mucus hypersecretion (CMH), chronic rhinosinusitis (CRS), oral corticosteroid (OCS) dosage, eosinophils in peripheral blood and FeNO were recorded. The Bhalla score was used for radiological assessment of T2-SA+BE patients and the Bronchiectasis Severity Index (BSI) was calculated.

Results

A total of 113 patients (mean age 55 ± 11 years, 59.3% female) were enrolled. Co-presence of BE was confirmed in 50/113 (44.2%) patients who identified the T2-SA+BE group. CRS and CRSwNP were more prevalent in T2-SA+BE vs T2-SA [respectively, 42/50 (84%) vs 37/63 (58.7%), p = 0.004 and 27/50 (54%) vs 27/63 (42.9%), p = 0.0165]. Furthermore, T2-SA+BE patients reported more CMH compared to T2-SA [29/50 (58%) vs 15/63 (23.8%), p = 0.0004], were more frequently on chronic OCSs intake [28/50 (56%) vs 22/63 (34.9%), p = 0.0357] and experienced more exacerbations/year [10 (4–12) vs 6 (4–12), p = 0.0487]. In a multivariate logistic regression model, the presence of CRS, CMH and daily OCS intake were associated with BE presence with a 78% (95% CI: 69–88) accuracy. Median Bhalla score was 18.3 (16–20) (Mild radiological severity). Median BSI was 6 (4–8) and only 6/50 (12%) had a BSI score ≥9. Significant inverse linear relationship between BSI and ACT (r = −0.6095, p < 0.0001), FEV₁% (r = −0.3297, p = 0.0353) and FEV₁ mL (r = −0.4339, p = 0.0046) were found.

Conclusion

Type 2 inflammation could have a causative role in BE development. Chest HRCT is mandatory when a diagnosis of T2-SA is made, especially in presence of CRS, CMH and chronic OCS intake. Early BE detection may be crucial to improve T2-SA patients’ outcomes.

Keywords:

• type 2 inflammation
• severe asthma
• bronchiectasis
• chest-CT scan
• phenotype

Abbreviations

SA, severe asthma; T2-SA, type 2-high severe asthma; BE, bronchiectasis; ACT, asthma control test; ABPA, allergic bronchopulmonary aspergillosis; CRSwNP, chronic rhinosinusitis with nasal polyps; CMH, chronic mucus hypersecretion; BSI, Bronchiectasis Severity Index; BMI, body mass index; FeNO, fractional exhaled nitric oxide; OCS, oral corticosteroids (Prednisone); ICS, inhaled corticosteroids; LABA, long-acting beta agonist; LAMA, long-acting muscarinic antagonist; FEV₁, forced expiratory volume in the 1st second; FVC, forced vital capacity; GERD, gastroesophageal reflux disease; IgE, immunoglobulin-E; IL-5, interleukin-5; IL-4, interleukin-4; IL-13, interleukin-13; HRCT, high resolution computed tomography.

Acknowledgment

The statistical analysis was designed and performed in collaboration with Filippo Palermo, Professor of Biostatistics at the University of Catania.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data, took part in drafting the article or revising it critically for important intellectual content, agreed to submit to the current journal, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

Prof. Dr. Enrico Heffler reports personal fees from AstraZeneca, Sanofi, Regeneron, Novartis, GSK, Circassia, Stallergenes-Greer, and Nestlè Purina, outside the submitted work. The authors report no other potential conflicts of interest for this work.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.