Related Experiment Video
Updated: May 28, 2026
Noninvasive Sampling of Mucosal Lining Fluid for the Quantification of In Vivo Upper Airway Immune-mediator Levels
Published on: August 7, 2017
Plasma metabolomic signatures associated with inhaled corticosteroid requirements in clinically stable asthma: a
Hyun Woo Lee1, Young Jin Pyung2, Sohee Oh3
1Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
Background:
Despite substantial clinical and biological heterogeneity, asthma severity is often classified by treatment intensity, which may inadequately reflect underlying pathobiology. We aimed to characterize plasma metabolomic profiles associated with treatment-defined severity among patients with clinically well-controlled asthma receiving guidance-based inhaled corticosteroid (ICS) therapy.
Methods:
In this prospective cross-sectional study, patients with well-controlled asthma, defined by Asthma Control Test scores > 20 and consistent ICS use without recent exacerbations, were enrolled. Plasma samples were analyzed using proton nuclear magnetic resonance spectroscopy and liquid chromatography-mass spectrometry. After asthma severity was defined by ICS dose requirement, metabolomic differences were evaluated between severe and non-severe asthma. The significant metabolites were identified through elastic net-assisted variable selection and Firth's penalized logistic regression adjusting for clinical covariates. Probabilistic relationships among these metabolites and severity were further explored using Bayesian network modeling.
Results:
Fifty-five patients were included. Lactate and pyruvate levels were significantly elevated in the severe asthma group. In multivariable analyses adjusting for clinical covariates, pyruvate (adjusted odds ratio (aOR) = 10.239 [95% CI = 1.320-19480.301], P-value = 0.025) and dimethylamine (aOR = 12.693 [95% CI = 1.292-628.175], P-value = 0.028) were associated with treatment-defined severity. Bayesian network analysis further supported the direct probabilistic associations of these metabolites with asthma severity. Subgroup analyses confirmed consistent trends across clinical strata, suggesting that distinct metabolic states may underlie higher ICS requirements despite stable symptom control.
Conclusion:
In clinically stable asthma, elevated pyruvate and dimethylamine were associated with greater ICS requirements, suggesting that metabolomic profiling may aid in refining endotypes and personalizing anti-inflammatory therapy beyond symptom-based assessment.
Related Concept Videos
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
01:26COPD: Management Using Bronchodilators and Corticosteroids
01:13Asthma III: Clinical Manifestations
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:25Antiasthma Drugs: Mast Cell Stabilizers and Anti-IgE Drugs
Mast cell stabilizers, such as cromolyn (also known as sodium cromoglycate) and nedocromil (Tilade), are effective drugs in asthma management. These stabilizers hinder histamine release by skillfully obstructing the activation of mast cells and other cellular entities. Notably, they navigate this task without...
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History