TY - JOUR T1 - Asthma phenotypes with rapid decline in lung function JF - European Respiratory Journal JO - Eur Respir J VL - 42 IS - Suppl 57 SP - 3039 AU - Tadao Nagasaki AU - Hisako Matsumoto AU - Yoshihiro Kanemitsu AU - Kneji Izuhara AU - Yuji Tohda AU - Hideo Kita AU - Takahiko Horiguchi AU - Kazunobu Kuwabara AU - Keisuke Tomii AU - Kojiro Otsuka AU - Masaki Fujimura AU - Noriyuki Ohkura AU - Katsuyuki Tomita AU - Akihito Yokoyama AU - Hiroshi Ohnishi AU - Yasutaka Nakano AU - Tetsuya Oguma AU - Soichiro Hozawa AU - Guergana Petrova AU - Isao Ito AU - Tsuyoshi Oguma AU - Hideki Inoue AU - Tomoko Tajiri AU - Toshiyuki Iwata AU - Yumi Izuhara AU - Junya Ono AU - Shoichiro Ohta AU - Akio Niimi AU - Michiaki Mishima Y1 - 2013/09/01 UR - http://erj.ersjournals.com/content/42/Suppl_57/3039.abstract N2 - Background Clustering approach has been used to classify heterogeneous asthma population into distinct phenotypes. However, longitudinal aspects of the phenotypes have been unclear.Objective To determine associations between phenotypes and annual decline in forced expiratory volume in one second (ΔFEV1) in asthmatic patients.Methods 224 adult asthmatic patients (mean age 62.3 years) treated with inhaled corticosteroid (ICS) for at least 4 years were enrolled. We applied cluster analysis to determine asthma phenotypes using seven variables: serum IgE levels, gender, age of asthma onset, BMI, %FEV1, asthma control test (ACT), and blood eosinophil counts. ΔFEV1, from at least one year after the initiation of ICS therapy to the time of enrollment or later (mean 16.2 measurements over 8 years per person), were assessed. Differences in clinical indices including ΔFEV1 and blood biomarkers at enrollment among clusters were analyzed.Results Four distinct phenotypes were determined. Cluster 1 (n = 25): late-onset, non-atopic, pauci-inflammatory (≤250 eosinophil/μL and ≤5000 neutrophil/μL), and preserved lung function. Cluster 2 (n = 105): early-onset, atopic, eosinophilic, and small decline in FEV1. Cluster 3 (n = 73): late-onset, eosinophilic, moderate decline in FEV1, and the highest serum periostin level among the four clusters. Cluster 4 (n = 21): mixed type (eosinophilic and neutrophilic) with the lowest FEV1, the greatest decline in FEV1, the lowest ACT score, and the highest serum IL-6 level among clusters. The proportions of patients with rapid FEV1 decline, defined as 30 ml·yr-1 or greater decline, were over 30% in clusters 3 and 4.Conclusions We identified asthma phenotypes with rapid FEV1 decline using a cluster analysis. ER -