Asthma inflammatory phenotypes on four continents: most asthma is non-eosinophilic

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dc.citation.issue2
dc.citation.volume52
dc.contributor.authorPembrey L
dc.contributor.authorBrooks C
dc.contributor.authorMpairwe H
dc.contributor.authorFigueiredo CA
dc.contributor.authorOviedo AY
dc.contributor.authorChico M
dc.contributor.authorAli H
dc.contributor.authorNambuya I
dc.contributor.authorTumwesige P
dc.contributor.authorRobertson S
dc.contributor.authorRutter CE
dc.contributor.authorvan Veldhoven K
dc.contributor.authorRing S
dc.contributor.authorBarreto ML
dc.contributor.authorCooper PJ
dc.contributor.authorHenderson J
dc.contributor.authorCruz AA
dc.contributor.authorDouwes J
dc.contributor.authorPearce N
dc.contributor.authorWASP Study Group
dc.coverage.spatialEngland
dc.date.accessioned2023-06-21T21:35:06Z
dc.date.available2023-04-19
dc.date.available2022-08-14
dc.date.available2023-06-21T21:35:06Z
dc.date.issued2023-04
dc.descriptionThis is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/
dc.description.abstractBACKGROUND: Most studies assessing pathophysiological heterogeneity in asthma have been conducted in high-income countries (HICs), with little known about the prevalence and characteristics of different asthma inflammatory phenotypes in low-and middle-income countries (LMICs). This study assessed sputum inflammatory phenotypes in five centres, in Brazil, Ecuador, Uganda, New Zealand (NZ) and the United Kingdom (UK). METHODS: We conducted a cross-sectional study of 998 asthmatics and 356 non-asthmatics in 2016-20. All centres studied children and adolescents (age range 8-20 years), except the UK centre which involved 26-27 year-olds. Information was collected using questionnaires, clinical characterization, blood and induced sputum. RESULTS: Of 623 asthmatics with sputum results, 39% (243) were classified as eosinophilic or mixed granulocytic, i.e. eosinophilic asthma (EA). Adjusted for age and sex, with NZ as baseline, the UK showed similar odds of EA (odds ratio 1.04, 95% confidence interval 0.37-2.94) with lower odds in the LMICs: Brazil (0.73, 0.42-1.27), Ecuador (0.40, 0.24-0.66) and Uganda (0.62, 0.37-1.04). Despite the low prevalence of neutrophilic asthma in most centres, sputum neutrophilia was increased in asthmatics and non-asthmatics in Uganda. CONCLUSIONS: This is the first time that sputum induction has been used to compare asthma inflammatory phenotypes in HICs and LMICs. Most cases were non-eosinophilic, including in settings where corticosteroid use was low. A lower prevalence of EA was observed in the LMICs than in the HICs. This has major implications for asthma prevention and management, and suggests that novel prevention strategies and therapies specifically targeting non-eosinophilic asthma are required globally.
dc.description.publication-statusPublished
dc.format.extent611 - 623
dc.identifierhttps://www.ncbi.nlm.nih.gov/pubmed/36040171
dc.identifier6678972
dc.identifier.citationInt J Epidemiol, 2023, 52 (2), pp. 611 - 623
dc.identifier.doi10.1093/ije/dyac173
dc.identifier.eissn1464-3685
dc.identifier.elements-id455734
dc.identifier.harvestedMassey_Dark
dc.languageeng
dc.publisherOxford University Press on behalf of the International Epidemiological Association
dc.relation.isPartOfInt J Epidemiol
dc.rights(c) The authors CC BY-NC-ND 4.0
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectAsthma
dc.subjectHIC
dc.subjectLMIC
dc.subjectadolescents
dc.subjectchildren
dc.subjectinflammatory phenotypes
dc.subjectsputum induction
dc.subjectHumans
dc.subjectCross-Sectional Studies
dc.subjectAsthma
dc.subjectPhenotype
dc.subjectBrazil
dc.subjectNew Zealand
dc.subject.anzsrc0104 Statistics
dc.subject.anzsrc1117 Public Health and Health Services
dc.titleAsthma inflammatory phenotypes on four continents: most asthma is non-eosinophilic
dc.typeJournal article
pubs.notesNot known
pubs.organisational-group/Massey University
pubs.organisational-group/Massey University/College of Health
pubs.organisational-group/Massey University/College of Health/Research Centre for Hauora and Health
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