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Type 2 Low Biomarker Stability and Exacerbations in Severe Uncontrolled Asthma
Arja Viinanen1,2, Juhani Aakko3, Mariann I Lassenius3
1Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, 20014 Turku, Finland.
Biomolecules
|July 29, 2023
Summary
The T2 low asthma biomarker profile, identified by blood eosinophil counts (BEC) and fractional exhaled nitric oxide (FeNO), is stable in a majority of severe uncontrolled asthma patients. This stability is crucial for accurate diagnosis and treatment strategies.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Biomarker Research
Background:
- Severe uncontrolled asthma management requires precise patient phenotyping.
- The T2 low asthma phenotype, characterized by specific biomarker levels, is not well-defined, and its longitudinal stability is largely unknown.
- Understanding T2 low biomarker stability is critical for effective treatment strategies in severe asthma.
Purpose of the Study:
- To investigate the stability of T2 low status using blood eosinophil counts (BEC) and fractional exhaled nitric oxide (FeNO) in patients with severe uncontrolled asthma.
- To determine the exacerbation rates in T2 low versus non-T2 low asthma phenotypes.
- To assess the reliability of BEC and FeNO as biomarkers for identifying and monitoring T2 low asthma over time.
Main Methods:
- Retrospective analysis of clinical data from severe uncontrolled asthma patients with at least two BEC and FeNO measurements.
- Stratification of patients into T2 low and non-T2 low groups based on established BEC (<150 or <300 cells/µL) and FeNO (<25 ppb) thresholds.
- Assessment of biomarker status stability, exacerbation rates requiring hospital care, and medication doses (OCS, ICS) over a 4-year follow-up period.
Main Results:
- 18% of patients were classified as T2 low using BEC <150 cells/µL and FeNO <25 ppb, while 39% were T2 low using BEC <300 cells/µL and FeNO <25 ppb.
- The T2 low biomarker profile demonstrated stability in 55% (T2 low150) and 72% (T2 low300) of patients with available follow-up data.
- Exacerbation rates were higher in the T2 low150 group (19.7 per 100 patient-years) compared to the non-T2 low150 group (8.4 per 100 patient-years).
Conclusions:
- Blood eosinophil counts (BEC) and fractional exhaled nitric oxide (FeNO) are valuable biomarkers for identifying T2 low severe uncontrolled asthma.
- The T2 low asthma phenotype exhibits a stable biomarker profile in a significant proportion of patients, supporting its clinical utility.
- Regular monitoring of BEC and FeNO is recommended for accurate identification and management of patients with T2 low asthma.
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