Characteristics of Severe Non-Eosinophilic Asthma: Analysis of Data from 1075 Patients Included in the FASE-CPHG Study

Abstract

Purpose

Data on severe non-eosinophilic asthma are scarce. Moreover, as compared with eosinophilic asthma, non-eosinophilic asthma less frequently benefits from the latest therapeutic advances. This study aimed to highlight differences between non-eosinophilic and eosinophilic asthma as they may help the development of new therapeutic agents.

Patients and Methods

Data from 1075 adult patients with severe asthma (GINA treatment: 4/5) collected during the cross-sectional non-interventional FASE-CPHG study were analyzed. Two groups of patients (EOS-/EOS+) were constituted based on blood eosinophil counts (cutoff value: 300 G/l). Characteristics of EOS- (N = 500) and EOS+ (N = 575) patients were described; EOS- patients were also described according to their allergic profile based on skin allergy or allergen-specific immunoglobulin E (IgE) assays (cutoff value: 150 IU/mL).

Results

Percentages of patients with obesity (29%), allergen sensitization (57%), or ≥2 annual exacerbations in the last 12 months (68%) were similar in both groups. As compared with EOS+ patients, EOS- patients less frequently reported chronic rhinitis (41.1% vs 50.5%, p < 0.01) or nasal polyposis (13.6% vs 27.5%, p < 0.01), and more frequently reported GERD (45.2% vs 37.1%, p < 0.01), anxiety (45.5% vs 38.1%, p = 0.01), or depression (18.3% vs 13.3%, p = 0.02). EOS- patients had lower serum total IgE levels (median: 158 vs 319 IU/mL, p < 0.01) and were less frequently treated with long-term oral corticosteroid therapy (16.0% vs 23.7%; p < 0.01). Their asthma was more frequently uncontrolled (48% vs 40%, p < 0.01). Similar results were found with a cutoff value for blood eosinophil counts at 150 G/l. EOS- patients with allergic profile less frequently reported high serum IgE levels (35.6% vs 57.9%, p < 0.01). EOS- and EOS+ patients treated with long-term oral corticosteroids had similar profiles.

Conclusion

In our patients with severe asthma, EOS- asthma was approximately as frequent as EOS+ asthma; EOS- asthma was frequently poorly controlled or uncontrolled, confirming the need for a better management. Allergy did not appear to worsen clinical profile.

Keywords:

• asthma
• eosinophils
• France
• hospital
• observational study

Abbreviations

ACT, Asthma Control Test; ALL, allergic; ATS, American Thoracic Society; CCTIRS, Comité Consultatif sur le Traitement de l’Information en matière de Recherche dans le domaine de la Santé; CI, confidence interval; CPHG, Collège des Pneumologues des Hôpitaux Généraux; CXCR2, chemokine receptor 2; EOS, eosinophil or eosinophilic; ENT, ear, nose, and throat; ERS, European Respiratory Society; G, giga; GERD, gastroesophageal reflux disease; GINA, Global Initiative for Asthma; ICS, inhaled corticosteroids; IgE, immunoglobulin E; IQR, interquartile range; IU, international unit; LABA, long-acting β2 agonist; LAMA: long-acting muscarinic antagonist; MAPK, mitogen-activated protein kinase; N, number; OCS, long-term oral corticosteroids; PDE, phosphodiesterase; PI, phosphoinositide; PPARγ, peroxisome proliferator-activated receptor gamma; SD, standard deviation; TSLP, thymic stromal lymphopoietin; WSAS, West Sweden Asthma Study.

Data Sharing Statement

The database is available upon request to Kappa Santé, a contract research organization.

Acknowledgments

The authors would like to thank the Collège des Pneumologues des Hôpitaux Généraux (CPHG, France) which initiated the FASE-CPHG study, Kappa Santé company (Paris, France) for the management of collected data, and Abelia Science (Saint-Georges-sur-Baulche, France) for providing medical writing support.

The authors also thank the FASE-CPHG participants and investigators for making this study possible: Dr Parrat (CH Papeete); Dr Nocent (CH Bayonne); Dr Mangiapan (CHI Créteil); Dr Prud’homme and Dr Courdeau-Labourie and Dr Demaegdt (CH Tarbes); Dr Oster and Dr Moreau and Dr Allibe (CH Colmar); Dr Portel and Dr Roy (CH Libourne); Dr Appere De Vecchi (CH Argenteuil); Dr Maurer (CH Montfermeil); Dr Lepoulain Doubliez (CH Charleville Mezières); Dr Iamandi (CH Mulhouse); Dr Gourcerol (CH Pau); Dr Didi, Dr Decroisette and Dr Bertocchi (CH Pringy); Dr Barbare and Dr Moncelly (CH Meaux); Dr Tannous (CH Forbach); Dr Kelkel (CH Chambéry); Dr Rolland (CH Cannes); Dr Jouveshomme (Hôpital St-Joseph, Paris); Dr Bernier (CH Dinan); Dr Hauss, Dr Ould, Dr Vincent, Dr Van Mossevelde and Dr Gallego (CH Elbeuf); Dr Merzoug (CH Fougères); Dr Haddad (CH Lourdes); Dr Guerrero, Dr Jarjour, Dr Haouachi and Dr Goutorbe (CH Béziers); Dr Morel, Dr Lemaire and Dr Russier (CH Orléans); Dr Roge (CH Morlaix); Dr Dumont (CH Chauny); Dr Cavestri and Dr Just (CH Roubaix); Dr Colin (CH Versailles); Dr Goupil, Dr Mansour and Dr Paris (CH Le Mans); Dr Philippe and Dr Boitiaux (CH Cergy-Pontoise); Dr Simon (CH Compiègne); Dr Marcq, Dr Bizieux, Dr Guibert and Dr Caby (CH La Roche sur Yon); Dr Lecuyer (CH Saint-Quentin); Dr Merlusca (CH Sedan); Dr Blanc (CH Aix en Provence); Dr Langelot (CH Les Sables d’Olonne); Dr Tagu (CH Bar le Duc); Dr Leveiller, Dr Duriel-Niel and Dr Coëtmeur (CH Saint-Brieuc); Dr Ilie (CH Dunkerque); Dr Raspopa (CH Toulon); Dr Lerousseau and Dr Rotomondo (CH Antibes); Dr Gramada (CH Sarreguemines); Dr Cornu and Dr Petit (CH Verdun); Dr Kraemer (CH Fréjus); Dr Guy (CH Vannes); Dr Gentil, Dr Luciani and Dr Lucena (CH Bourgoin Jallieu); Dr Michaux (CH Macon); Dr Maitre (CH Vesoul); Dr De Faverges (CH Nevers); Dr Fouret (CH Villeneuve Saint-Georges); Dr Goarant (CH Saint-Malo); Dr Bara and Dr Hamoudi (CH Angoulême); Dr Maetz (CH Douai); Dr Yousef and Dr Lungoci (CH Le Puy en Velay); Dr Al Freijat (CH Belfort); Dr Assemi (CH Saverne); Dr Beysens (CH Saintes); Dr Clarissou (CH Beaumont sur Oise); Dr Karimo (CH Saint-Omer); Dr Saadi (CH Barbezieux Saint Hilaire); Dr Barre and Dr Farny (CH Cahors); Dr Romand (CH Contamine sur Arve); Dr Leleu (CH Abbeville); Dr Bernard (CH Quimper); Dr Marangoni (CH Saint-Dié); Dr Fevrier (CH Saumur); Dr Paillot (CH Metz); Dr Bonnefoy (CH Jonzac); Dr Manoila (CH Evreux); Dr Abraham (CH Dax); Dr Lacroix (CH Périgueux); Dr Virally (CH Aulnay sous Bois).

Disclosure

CFV, AC and GT are employees of AstraZeneca. NT and DS are employees of Kappa Santé. The authors report no other conflicts of interest in this work.

Additional information

Funding

The FASE-CPHG study was supported by contributions made through the CPHG from ALK, AstraZeneca, Boehringer Ingelheim, GSK, and Le Nouveau Souffle. The funding bodies had no role on the conception of this manuscript, they did not participate in any way in the design of the FASE-CPHG study. AstraZeneca supported the secondary analysis of the data presented in the present article.