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The ENFUMOSA cross-sectional European multicentre study of the clinical phenotype of chronic severe asthma

The ENFUMOSA Study Group
European Respiratory Journal 2003 22: 470-477; DOI: 10.1183/09031936.03.00261903
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  • Fig. 1.—
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    Fig. 1.—

    Percentage of positive skin-prick tests to common aeroallergens in asthmatic patients with well-controlled (┘) or severe (□) asthma. #: represents the total number of subjects in each group with at least one positive reaction. Local 1 and Local 2 indicate the two most frequent allergens specific to the geographical region. *: p<0.05.

  • Fig. 2.—
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    Fig. 2.—

    Sputum differential cell count in subjects with severe asthma (┘; n=99) compared with subjects with well-controlled asthma (□; n=89). Data expressed as %±sem. There were no difference in total sputum cell counts between the groups (controlled asthma 4.6±0.5 million cells per gram versus 5.6±0.6 million cells per gram in the subjects with severe asthma). *: p<0.05.

Tables

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  • Table 1

    Participating centres

    City/countryUniversityHospital/affiliationsInvestigators
    Athens, GreeceUniversity of AthensSotiria Chest Hospital Evgenidio Hospital AstraZenecaM. Gaga, N. Papageorgiou C. Gratziou G. Yourgioti
    Barcelona, SpainInstitut Municipal d'Investigació MèdicaHospital del Mar Novartis Global EpidemiologyJ.M. Antó, E. Barreiro, C. Sanjuas J. Castellsague
    Ferrara, ItalyUniversita degli Studi di FerraraClinica di Malattie dell’Apparato RespiratorioL.M. Fabbri#, A. Papi, M. Romagnoli
    Ghent, BelgiumUniversity of GhentGhent University HospitalJ.C. Kips, R.A. Pauwels
    Groningen, The NetherlandsUniversity of GroningenUniversity Hospital, GroningenH.A.M. Kerstjens, D.S. Postma, W. Timens
    Hamburg, GermanyUniversity of HamburgKrankenhaus GroβhansdorfN. Drews, F. Kanniess, H. Magnussen, K. Richter
    Heraklion, GreeceUniversity of HeraklionHeraklion University HospitalN.M. Siafakas, N. Tzanakis
    Leiden, The NetherlandsLeiden UniversityLeiden University Medical Centre Leyenburg HospitalE.H.D. Bel, K.F. Rabe A.C. Roldaan
    Montpellier, FranceUniversity of MontpellierHopital Arnaud de VilleneuveJ. Bousquet, P. Chanez, I. Vachier
    Palermo, ItalyUniversita degli Studi di PalermoOspedale V CervelloG. Bonsignore, F. Cibella, G. Cuttitta, G. Guerrera, A.M. Vignola
    Southampton, UKUniversity of SouthamptonSouthampton General HospitalB. Abraham, R. Djukanovic, S.T. Holgate, P.H. Howarth, S.L. Johnston¶, L. Watson
    Stockholm, SwedenKarolinska InstitutetKarolinska HospitalB. Dahlén+, S-E. Dahlén, M. Kumlin, A. Roquet
    Utrecht, The NetherlandsUniversity of Utrecht(analytical centre)G. Folkerts, F.P. Nijkamp
    • Current affiliations: #: University of Modena, Italy

    • ¶: Imperial College, London, UK

    • +: Huddinge University Hospital, Stockholm, Sweden

  • Table 2

    Study subjects' demographic and clinical characteristics

    Controlled asthmaSevere asthmaControlled versus severe asthma
    Subjects n158163
    Age yr40.9±14.342.4±12.1ns
    Sex ratio female:male1.6:14.4:1p<0.001
    Height cm
     Male175.3±8.4172.2±7.6ns
     Female161.7±8.1161.7±7.4ns
    Weight kg
     Male78.6±14.980.4±16.3ns
     Female66.5±11.470.9±15.5p<0.05
    BMI kg·m−2
     Male26.3±6.426.5±4.2ns
     Female25.6±4.927.2±6.0p<0.05
    Systolic BP mmHg
     Male127.0±24.6131.4±11.9p<0.01
     Female123.1±20.1130.2±19.7p<0.01
    Diastolic BP mmHg
     Male79.6±10.783.1±7.0p<0.001
     Female76.8±10.882.0±12.1p<0.001
    Heart frequency beats·min−1
     Male67.7±10.882.3±19.3p<0.001
     Female73.9±9.282.7±14.6p<0.001
    Respiratory rate per min
     Male15.4±3.616.7±3.5ns
     Female16.9±4.218.1±4.5ns
    p<0.01¶
    Dose of inhaled steroid#666±2851676±667p<0.001
    • All data are expressed as mean±sd unless otherwise indicated

    • BMI: body mass index

    • BP; blood pressure

    • #: steroid expressed as beclomethasone equivalents

    • ¶: for males and females combined

  • Table 3

    Sex ratio distribution among subjects with severe asthma from the different participating centres

    CentreSevere asthma nFemale n (%)Ratio female:male
    Montpellier159 (60)1.50
    Groningen86 (75)3.00
    Leiden129 (75)2.25
    Palermo1713 (76)3.25
    Ghent97 (78)3.50
    Ferrara1411 (79)3.67
    Grosshansdorf108 (80)4.00
    Barcelona87 (88)7.00
    Southampton1816 (89)8.00
    Stockholm2018 (90)9.00
    Athens2119 (90)9.50
    Heraklion1110 (91)10.00
    Total163133 (82)
    • Mean odds ratio female versus male (95% CI): 2.69 (1.6–4.49)

    • Chi-squared p‐value 0.001

  • Table 4

    Pulmonary function tests (per cent of predicted) and blood gases

    Controlled asthmaSevere asthmaControlled versus severe asthma
    Subjects n130133–153#
    FEV188.5±18.171.8±23.1p<0.001
    FEV1 post salbutamol97.6±17.880.9±24.1p<0.001
    FVC103.1±16.194.1±21.1p<0.001
    FEV1/FVC89.7±12.879.9±16.6p<0.001
    TLC104.1±13.4104.4±15.2ns
    RV/TLC104.2±23.0113.4±28.0p<0.01
    K CO 95.0±16.790.6±19.0p<0.05
    Pa,O2 kPa12.0±1.611.2±1.9p<0.001
    Pa,CO2 kPa5.1±0.54.9±0.5p<0.01
    pH7.41±0.037.42±0.03ns
    HCO3 mmol·L−124.8±2.424.3±2.4ns
    Base excess mmol·L−10.7±2.30.4±2.2ns
    • Data presented as mean±sd

    • FEV1: forced expiratory volume in one second

    • FVC: forced vital capacity

    • TLC: total lung capacity

    • ns: not significant

    • RV: residual volume

    • KCO: carbon monoxide transfer coefficient

    • Pa,O2: arterial oxygen tension

    • Pa,CO2: carbon dioxide arterial tension

    • #: Twenty subjects did not perform all spirometry measurements or blood gases

  • Table 5

    Biomarkers of inflammation

    Controlled asthmaSevere asthmaControlled versus severe asthma
    Peripheral WBC
     Subjects n130162ns
     Total count ×109·L−16.7±1.78.6±3.4<0.05
     Monocytes %7.2±2.46.5±2.1ns
     Neutrophils %57.3±8.361.2±12.1<0.05
     Lymphocytes %30.4±7.127.1±9.3ns
     Eosinophils %4.1±3.14.4±5.0ns
     Basophils %0.7±0.80.7±0.8ns
    Urinary mediators
     Subjects n136153
     LTE4 ng·mmol−1 creatinine48±5.858±7.7#<0.05
     EPX µg·mmol−1 creatinine45±4.662±9.3#<0.05
    Exhaled NO
     Subjects n4550
     Geometric mean ppb# (95% CI)9.2 (7.0–7.3)9.8 (7.3–13.2)ns
    • Data are presented as mean±sd unless otherwise indicated

    • WBC: white blood count

    • LTE4: leukotriene E4: EPX: eosinophil protein X

    • NO: nitric oxide

    • CI: confidence interval

    • #: age and sex adjusted

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The ENFUMOSA cross-sectional European multicentre study of the clinical phenotype of chronic severe asthma
The ENFUMOSA Study Group
European Respiratory Journal Sep 2003, 22 (3) 470-477; DOI: 10.1183/09031936.03.00261903

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The ENFUMOSA cross-sectional European multicentre study of the clinical phenotype of chronic severe asthma
The ENFUMOSA Study Group
European Respiratory Journal Sep 2003, 22 (3) 470-477; DOI: 10.1183/09031936.03.00261903
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