Journal of Asthma and Allergy (Nov 2021)

Type 2-High Severe Asthma with and without Bronchiectasis: A Prospective Observational Multicentre Study

  • Crimi C,
  • Campisi R,
  • Nolasco S,
  • Ferri S,
  • Cacopardo G,
  • Impellizzeri P,
  • Pistorio MP,
  • Fagone E,
  • Pelaia C,
  • Heffler E,
  • Crimi N

Journal volume & issue
Vol. Volume 14
pp. 1441 – 1452

Abstract

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Claudia Crimi,1 Raffaele Campisi,1 Santi Nolasco,2 Sebastian Ferri,3,4 Giulia Cacopardo,5 Pietro Impellizzeri,2 Maria Provvidenza Pistorio,2 Evelina Fagone,2 Corrado Pelaia,6 Enrico Heffler,3,4 Nunzio Crimi1,2 1Respiratory Medicine Unit, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy; 2Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; 3Personalized Medicine, Asthma and Allergy - IRCCS Humanitas Research Hospital, Rozzano, Italy; 4Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy; 5Respiratory Intensive Care Unit, ARNAS Civico General Hospital, Palermo, Italy; 6Department of Medical and Surgical Sciences, University “Magna Graecia”, Catanzaro, ItalyCorrespondence: Claudia CrimiRespiratory Medicine Unit, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, ItalyEmail [email protected]: Type 2-high severe asthma (T2-SA) is often associated with several comorbidities. To this extent, the coexistence of T2-SA and bronchiectasis (BE) is considered an emerging phenotype.Methods: We performed a prospective observational multicentre study, including T2-SA patients. Chest HRCT confirmed the presence of BE. Data on exacerbations, pulmonary function, Asthma Control Test (ACT), chronic mucus hypersecretion (CMH), chronic rhinosinusitis (CRS), oral corticosteroid (OCS) dosage, eosinophils in peripheral blood and FeNO were recorded. The Bhalla score was used for radiological assessment of T2-SA+BE patients and the Bronchiectasis Severity Index (BSI) was calculated.Results: A total of 113 patients (mean age 55 ± 11 years, 59.3% female) were enrolled. Co-presence of BE was confirmed in 50/113 (44.2%) patients who identified the T2-SA+BE group. CRS and CRSwNP were more prevalent in T2-SA+BE vs T2-SA [respectively, 42/50 (84%) vs 37/63 (58.7%), p = 0.004 and 27/50 (54%) vs 27/63 (42.9%), p = 0.0165]. Furthermore, T2-SA+BE patients reported more CMH compared to T2-SA [29/50 (58%) vs 15/63 (23.8%), p = 0.0004], were more frequently on chronic OCSs intake [28/50 (56%) vs 22/63 (34.9%), p = 0.0357] and experienced more exacerbations/year [10 (4– 12) vs 6 (4– 12), p = 0.0487]. In a multivariate logistic regression model, the presence of CRS, CMH and daily OCS intake were associated with BE presence with a 78% (95% CI: 69– 88) accuracy. Median Bhalla score was 18.3 (16– 20) (Mild radiological severity). Median BSI was 6 (4– 8) and only 6/50 (12%) had a BSI score ≥ 9. Significant inverse linear relationship between BSI and ACT (r = − 0.6095, p < 0.0001), FEV1% (r = − 0.3297, p = 0.0353) and FEV1 mL (r = − 0.4339, p = 0.0046) were found.Conclusion: Type 2 inflammation could have a causative role in BE development. Chest HRCT is mandatory when a diagnosis of T2-SA is made, especially in presence of CRS, CMH and chronic OCS intake. Early BE detection may be crucial to improve T2-SA patients’ outcomes.Keywords: type 2 inflammation, severe asthma, bronchiectasis, chest-CT scan, phenotype

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