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Identification of asthma phenotypes based on extrapulmonary treatable traits

Patricia Duarte Freitas, Rafaella França Xavier, Vanessa Marie McDonald, Peter Gerard Gibson, Laura Cordova-Rivera, Karina Couto Furlanetto, Joice Mara de Oliveira, Regina Maria Carvalho-Pinto, Alberto Cukier, Rafael Stelmach, Celso Ricardo Fernandes Carvalho
European Respiratory Journal 2021 57: 2000240; DOI: 10.1183/13993003.00240-2020
Patricia Duarte Freitas
1Dept of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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  • ORCID record for Patricia Duarte Freitas
Rafaella França Xavier
1Dept of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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Vanessa Marie McDonald
2National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia
3Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia
4Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
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Peter Gerard Gibson
2National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia
3Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia
4Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
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Laura Cordova-Rivera
2National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia
3Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia
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Karina Couto Furlanetto
5Biological and Health Sciences Center, UNOPAR Pitágoras University, Londrina, Brazil
6Laboratory of Research in Pulmonary Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
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Joice Mara de Oliveira
5Biological and Health Sciences Center, UNOPAR Pitágoras University, Londrina, Brazil
6Laboratory of Research in Pulmonary Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
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Regina Maria Carvalho-Pinto
7Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
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Alberto Cukier
7Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
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Rafael Stelmach
7Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
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Celso Ricardo Fernandes Carvalho
1Dept of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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  • For correspondence: cscarval@usp.br
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Abstract

Asthma is a heterogeneous and complex disease, and a description of asthma phenotypes based on extrapulmonary treatable traits has not been previously reported.

The objective of this study was to identify and characterise clusters based on clinical, functional, anthropometrical and psychological characteristics in participants with moderate-to-severe asthma.

This was a cross-sectional multicentre study involving centres from Brazil and Australia. Participants (n=296) with moderate-to-severe asthma were consecutively recruited. Physical activity and sedentary time, clinical asthma control, anthropometric data, pulmonary function and psychological and health status were evaluated. Participants were classified by hierarchical cluster analysis and the clusters compared using ANOVA, Kruskal­–Wallis and Chi-squared tests. Multiple logistic and linear regression models were performed to evaluate the association between variables.

We identified four clusters: 1) participants with controlled asthma who were physically active; 2) participants with uncontrolled asthma who were physically inactive and more sedentary; 3) participants with uncontrolled asthma and low physical activity, who were also obese and experienced anxiety and/or depression symptoms; and 4) participants with very uncontrolled asthma who were physically inactive, more sedentary, obese and experienced anxiety and/or depression symptoms. Higher levels of sedentary time, female sex and anxiety symptoms were associated with increased odds of exacerbation risk, while being more active showed a protective factor for hospitalisation. Asthma control was associated with sex, the occurrence of exacerbation, physical activity and health status.

Physical inactivity, obesity and symptoms of anxiety and/or depression were associated with worse asthma outcomes, and closely and inextricably associated with asthma control. This cluster analysis highlights the importance of assessing extrapulmonary traits to improve personalised management and outcomes for people with moderate and severe asthma.

Abstract

Cluster analysis based on extrapulmonary treatable traits in people with moderate-to-severe asthma indicates that physical inactivity, higher levels of sedentary time, symptoms of anxiety and depression, and obesity are associated with worse outcomes. https://bit.ly/2ATv1Ce

Footnotes

  • This article has supplementary material available from erj.ersjournals.com

  • Author contributions: Study concept and design: P.D. Freitas, R.M. Carvalho-Pinto, A. Cukier, R. Stelmach and C.R.F. Carvalho; data acquisition: P.D. Freitas, V.M. McDonald, L. Cordova-Rivera, K.C. Furlanetto and J.M. de Oliveira; data analysis and/or interpretation: P.D. Freitas, R.F. Xavier, V.M. McDonald, P.G. Gibson, L. Cordova-Rivera, K.C. Furlanetto, J.M. de Oliveira, R.M. Carvalho-Pinto, A. Cukier, R. Stelmach and C.R.F. Carvalho; manuscript writing and/or critical revisions for important intellectual content: P.D. Freitas, R.F. Xavier, V.M. McDonald, P.G. Gibson, L. Cordova-Rivera, K.C. Furlanetto, J.M. de Oliveira, R.M. Carvalho-Pinto, A. Cukier, R. Stelmach and C.R.F. Carvalho. All the authors have read and approved the final version of the manuscript.

  • Conflict of interest: P.D. Freitas has nothing to disclose.

  • Conflict of interest: R.F. Xavier has nothing to disclose.

  • Conflict of interest: V.M. McDonald has nothing to disclose.

  • Conflict of interest: P.G. Gibson has nothing to disclose.

  • Conflict of interest: L. Cordova-Rivera has nothing to disclose.

  • Conflict of interest: K.C. Furlanetto has nothing to disclose.

  • Conflict of interest: J.M. de Oliveira has nothing to disclose.

  • Conflict of interest: R.M. Carvalho-Pinto has nothing to disclose.

  • Conflict of interest: A. Cukier has nothing to disclose.

  • Conflict of interest: R. Stelmach has nothing to disclose.

  • Conflict of interest: C.R.F. Carvalho has nothing to disclose.

  • Support statement: The study was supported by the grant 2016/17093-0 from the Sao Paulo Research Foundation (FAPESP), by the grant 311443/2014-1 from the Ministério da Ciência, Tecnologia e Inovação - Conselho Nacional de Pesquisa (CNPq) and by the John Hunter Hospital Charitable Trust Grant Scheme, The Hunter Medical Research Institute and the University of Newcastle. Funding information for this article has been deposited with the Crossref Funder Registry.

  • Received February 4, 2020.
  • Accepted July 6, 2020.
  • Copyright ©ERS 2021
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Identification of asthma phenotypes based on extrapulmonary treatable traits
Patricia Duarte Freitas, Rafaella França Xavier, Vanessa Marie McDonald, Peter Gerard Gibson, Laura Cordova-Rivera, Karina Couto Furlanetto, Joice Mara de Oliveira, Regina Maria Carvalho-Pinto, Alberto Cukier, Rafael Stelmach, Celso Ricardo Fernandes Carvalho
European Respiratory Journal Jan 2021, 57 (1) 2000240; DOI: 10.1183/13993003.00240-2020

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Identification of asthma phenotypes based on extrapulmonary treatable traits
Patricia Duarte Freitas, Rafaella França Xavier, Vanessa Marie McDonald, Peter Gerard Gibson, Laura Cordova-Rivera, Karina Couto Furlanetto, Joice Mara de Oliveira, Regina Maria Carvalho-Pinto, Alberto Cukier, Rafael Stelmach, Celso Ricardo Fernandes Carvalho
European Respiratory Journal Jan 2021, 57 (1) 2000240; DOI: 10.1183/13993003.00240-2020
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