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Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
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Type 2-High Severe Asthma with and without Bronchiectasis: A Prospective Observational Multicentre Study.

Claudia Crimi1, Raffaele Campisi1, Santi Nolasco2

  • 1Respiratory Medicine Unit, A.O.U. Policlinico "G. Rodolico - San Marco", Catania, Italy.

Journal of Asthma and Allergy
|December 9, 2021
PubMed
Summary

Type 2-high severe asthma (T2-SA) patients frequently have bronchiectasis (BE). Chronic rhinosinusitis, mucus hypersecretion, and oral corticosteroid use are linked to BE in T2-SA, highlighting the need for early detection.

Keywords:
bronchiectasischest-CT scanphenotypesevere asthmatype 2 inflammation

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Area of Science:

  • Pulmonology
  • Respiratory Medicine
  • Clinical Science

Background:

  • Type 2-high severe asthma (T2-SA) is increasingly recognized with comorbidities.
  • Bronchiectasis (BE) co-occurrence with T2-SA represents an emerging and significant clinical phenotype.

Purpose of the Study:

  • To investigate the prevalence and clinical characteristics of bronchiectasis in patients with T2-SA.
  • To identify factors associated with the presence of BE in the T2-SA population.

Main Methods:

  • Prospective observational multicenter study involving T2-SA patients.
  • Chest High-Resolution Computed Tomography (HRCT) for BE diagnosis.
  • Data collection included exacerbations, pulmonary function, Asthma Control Test (ACT), chronic mucus hypersecretion (CMH), chronic rhinosinusitis (CRS), oral corticosteroid (OCS) use, and biomarkers (blood eosinophils, FeNO).
  • Radiological assessment using Bhalla score and Bronchiectasis Severity Index (BSI).

Main Results:

  • 44.2% of T2-SA patients (50/113) had co-existing BE.
  • T2-SA+BE patients showed higher prevalence of CRS (84% vs 58.7%), CMH (58% vs 23.8%), and chronic OCS intake (56% vs 34.9%).
  • T2-SA+BE patients experienced more exacerbations/year (10 vs 6).
  • CRS, CMH, and daily OCS intake accurately predicted BE presence (78% accuracy).
  • Significant inverse relationships were found between BSI and ACT, FEV1% predicted, and FEV1 mL.

Conclusions:

  • Type 2 inflammation may play a causal role in the development of BE.
  • Chest HRCT is essential for T2-SA diagnosis, particularly with CRS, CMH, and OCS use.
  • Early detection of BE is crucial for improving outcomes in T2-SA patients.