Identification of asthma phenotypes based on extrapulmonary treatable traits
- Patricia Duarte Freitas1,
- Rafaella França Xavier1,
- Vanessa Marie McDonald2,3,4,
- Peter Gerard Gibson2,3,4,
- Laura Cordova-Rivera2,3,
- Karina Couto Furlanetto5,6,
- Joice Mara de Oliveira5,6,
- Regina Maria Carvalho-Pinto7,
- Alberto Cukier7,
- Rafael Stelmach7 and
- Celso Ricardo Fernandes Carvalho1
- 1Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- 2National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, New South Wales, Australia
- 3Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, New South Wales, Australia
- 4Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
- 5Biological and Health Sciences Center, UNOPAR Pitágoras University, Londrina, Paraná, Brazil
- 6Laboratory of Research in Pulmonary Physiotherapy, State University of Londrina (UEL), Londrina, Paraná, Brazil
- 7Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
- Dr Celso R F Carvalho, Department of Medicine, School of Medicine, University of Sao Paulo, Av. Dr. Arnaldo 455, room 1210, Zip code: 01246-903 – Sao Paulo – SP, Brazil. E-mail: cscarval{at}usp.br
Abstract
Background Asthma is a heterogeneous and complex disease, and the description of asthma phenotypes based on extrapulmonary treatable traits has not been previously reported.
Objective to identify and characterise clusters based on clinical, functional, anthropometrical, and psychological characteristics in participants with moderate-to-severe asthma.
Methods This is 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, psychological, and health-status were evaluated. Participants were classified by hierarchical cluster analysis and the clusters compared using ANOVA, Kruskal-Wallis, and Chi-square tests. Multiple logistic and linear regression models were performed to evaluate the association between variables.
Results We identified four clusters: (1)controlled asthma who were physically active, (2)uncontrolled asthma who were physically inactive and more sedentary, (3)uncontrolled asthma with low physical activity, who were also obese and experienced anxiety and/or depression symptoms (4)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.
Conclusion Traits such as physical inactivity, obesity, and symptoms of anxiety and/or depression were associated with worse asthma outcomes, and closely and inextricably with asthma control. This cluster analysis supports the importance of assessing extrapulmonary traits to improve personalised management and outcomes for people with moderate and severe asthma.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. López-Abente has nothing to disclose.
Conflict of interest: Dr. Freitas has nothing to disclose.
Conflict of interest: Dr. Xavier has nothing to disclose.
Conflict of interest: Dr. McDonald has nothing to disclose.
Conflict of interest: Dr. Gibson has nothing to disclose.
Conflict of interest: Dr. Codorva-Rivera has nothing to disclose.
Conflict of interest: Dr. Furlanetto has nothing to disclose.
Conflict of interest: Dr. Oliveira has nothing to disclose.
Conflict of interest: Dr. Carvalho-Pinto has nothing to disclose.
Conflict of interest: Dr. Cukier has nothing to disclose.
Conflict of interest: Dr. Stelmach has nothing to disclose.
Conflict of interest: Dr. Carvalho has nothing to disclose.
This is a PDF-only article. Please click on the PDF link above to read it.
- Received February 4, 2020.
- Accepted July 6, 2020.
- Copyright ©ERS 2020