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Related Experiment Video

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Asthma phenotypes: do cough and wheeze predict exacerbations in persistent asthma?

Jaymin B Morjaria1,2, Alan S Rigby1, Alyn H Morice3

  • 1Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK.

The European Respiratory Journal
|December 9, 2017
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Summary

In uncontrolled asthma, cough and wheeze symptoms are common, especially in older, overweight individuals. Maintenance and reliever therapy (MART) reduced exacerbations more than salbutamol, particularly in patients with fewer symptoms.

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Area of Science:

  • Pulmonology
  • Clinical Medicine
  • Respiratory Medicine

Background:

  • Long-term symptom profiles in uncontrolled asthma remain poorly understood.
  • Identifying distinct asthma phenotypes based on symptoms is crucial for personalized treatment.

Purpose of the Study:

  • To assess the diurnal symptom profile of cough and wheeze in uncontrolled asthma.
  • To investigate how symptom profiles influence treatment response and exacerbation frequency.

Main Methods:

  • Analysis of twice-daily electronic symptom data from 1701 patients with uncontrolled asthma.
  • Comparison of reliever therapy with salbutamol versus extra-fine beclometasone/formoterol maintenance and reliever therapy (MART).
  • Correlation of exacerbation frequency with patient demographics and symptom profiles.

Main Results:

  • Cough and wheeze were more prevalent in older patients with higher body mass index.
  • Two phenotypes were identified: cough-predominant (overweight, older females) and wheeze-predominant (older males).
  • MART significantly reduced exacerbation frequency compared to salbutamol, with the greatest benefit in patients reporting fewer symptoms.

Conclusions:

  • While cough and wheeze are correlated, distinct symptom-predominant phenotypes exist in uncontrolled asthma.
  • Symptom frequency and exacerbation rates appear poorly associated, suggesting varied underlying pathophysiology.
  • MART may be a preferred treatment option for patients with fewer reported symptoms.