Author: Bjerregaard, A.; Laing, I. A.; Backer, V.; Sverrild, A.; Khoo, S.â€K.; Chidlow, G.; Sikazwe, C.; Smith, D. W.; Le Souëf, P.; Porsbjerg, C.
Title: High fractional exhaled nitric oxide and sputum eosinophils are associated with an increased risk of future virusâ€induced exacerbations: A prospective cohort study Cord-id: tckirkzn Document date: 2017_5_9
ID: tckirkzn
Snippet: BACKGROUND: The major trigger of asthma exacerbations is infection with a respiratory virus, most commonly rhinovirus. Type 2 inflammation is known to be associated with an increased risk of exacerbations in general. Whether type 2 inflammation at baseline increases the risk of future virusâ€induced exacerbations is unknown. OBJECTIVE: To assess whether type 2 inflammation is associated with an increased risk of virusâ€induced exacerbations of asthma. METHODS: Stable asthmatics had spirometry,
Document: BACKGROUND: The major trigger of asthma exacerbations is infection with a respiratory virus, most commonly rhinovirus. Type 2 inflammation is known to be associated with an increased risk of exacerbations in general. Whether type 2 inflammation at baseline increases the risk of future virusâ€induced exacerbations is unknown. OBJECTIVE: To assess whether type 2 inflammation is associated with an increased risk of virusâ€induced exacerbations of asthma. METHODS: Stable asthmatics had spirometry, skin prick test, measurement of FeNO and sputum induced for differential cell counts. Patients were followed up for 18 months, during which they were assessed at the research unit when they had symptoms of an exacerbation. Nasal swabs collected at these assessments underwent viral detection by PCR. RESULTS: A total of 81 asthma patients were recruited, of which 22 (27%) experienced an exacerbation during the followâ€up period. Of these, 15 (68%) had a respiratory virus detected at exacerbation. Sputum eosinophils >1% at baseline increased the risk of having a subsequent virusâ€induced exacerbation (HR 7.6 95% CI: 1.6â€35.2, P=.010) as did having FeNO >25 ppb (HR 3.4 95% CI: 1.1â€10.4, P=.033). CONCLUSION AND CLINICAL RELEVANCE: Established type 2 inflammation during stable disease is a risk factor for virusâ€induced exacerbations in a realâ€life setting. Measures of type 2 inflammation, such as sputum eosinophils and FeNO, could be included in the risk assessment of patients with asthma in future studies.
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