Analysis Of Clinical Characteristics And The Changes Of Airway Inflammation Phenotypes After Treatment In Bronchial Asthma Patients With Different Clinical Phenotypes

Objective:To study the clinical characteristics and the changes of airway inflammatory phenotypes after treatment in bronchial asthma patients with different clinical phenotypes.Methods:Using the retrospective study method,343 patients who were first diagnosed with asthma and completed induced sputum testing in the outpatient clinic of the Department of Respiratory and Critical Care Medicine of the First Hospital of Shanxi Medical University from October 2016 to December 2021 were selected,and were divided into classic asthma(CA)group and cough variant asthma(CVA)group according to symptoms.At the same time,258 patients with completed allergen-specific Ig E antibodies(s Ig E)were divided into allergic asthma(AA)group and nonallergic asthma(NAA)group according to whether they had a history of allergy and whether the allergen s Ig E≥grade 1(0.35 U/m L).In asthma patients with different clinical phenotypes,baseline data,type 2 inflammatory indicators[absolute value of peripheral eosinophil(EOS),proportion of induced sputum EOS(%),fractional exhaled nitric oxide(FeNO)],pulmonary ventilation function,airway inflammation phenotypes and there changes after treatment were analyzed.Results:1.Comparison between CA group and CVA group:1.1 The age of onset in the CA group was lower than that in the CVA group,and the difference was statistically significant(t=-1.996,P=0.047);the number of patients with rhinitis,sinusitis,and nasal polyps in the CA group was more than that in the CVA group,the difference was statistically significant(χ~2=9.716,P=0.002).1.2 The absolute value of blood EOS,induced sputum EOS%and FeNO in CA group were higher than those in CVA group,and the difference was statistically significant(Z=-4.602,Z=-4.699,Z=-4.049,all P=0.000);the number of patients with blood EOS>0.3×10~9/L,the number of patients with FeNO>25ppd were more than those in the CVA group,and the difference was statistically significant(χ~2=16.978,P=0.000 andχ~2=4.190,P=0.041).1.3 The indicators of pulmonary ventilation function in the CA group,such as FEV1%pred,FEV1/FVC,MEF25%pred,MEF50%pred and MMEF75/25%pred were lower than those in the CVA group,and the difference was statistically significant(t=-2.578,t=-3.105,t=-2.360,t=-1.977,t=-2.049,all P<0.05);there were more patients with small airway dysfunction(SAD)in the CA group than in the CVA group,and the difference was statistically significant(χ~2=4.603,P=0.032).1.4 There were no significant differences between the two groups in gender,age,body mass index(BMI),smoking rate,family history of asthma,urticaria and/or eczema,FVC%pred,PEF%pred and the number of patients with FEV1/FVC<80%(all P>0.05).1.5 Distribution of airway inflammatory phenotypes:89 cases(44.5%)of neutrophil(NEU)type,55 cases(27.5%)of eosinophilic(EOS)type,36 cases(18.0%)of mixed cell(MIX)type and 20 cases(10.0%)of paucigranulocytic(PAU)type in CA group,99 cases(69.2%)of NEU type,9 cases(6.3%)of EOS type,7 cases(4.9%)of MIX type and 28 cases(19.6%)of PAU type in CVA group,the difference was statistically significant(χ~2=46.292,P=0.000).There were 19/26 patients in the CA group and 4/7 patients in the CVA group had at least one change in airway inflammation phenotypes after treatment.2.Comparison between AA group and NAA group:2.1 The age and onset age of the AA group were lower than those of NAA group,and the difference was statistically significant(t=-2.126,P=0.034 and t=-2.358,P=0.019);the number of rhinitis and or sinusitis,nasal polyps in AA group were more than that in NAA group,and the difference was statistically significant(χ~2=9.089,P=0.003).2.2 The absolute value of blood EOS,induced sputum EOS%and FeNO in the AA group were higher than those in the NAA group,and the difference was statistically significant(Z=-2.403,Z=-2.569,Z=-2.214,all P<0.05).The number of patients with blood EOS>0.3×10~9/L was more than that of NAA group,the difference was statistically significant(χ~2=5.121,P=0.024).2.3 There were no differences between the two groups in gender,BMI,smoking rate,family history of asthma,combined urticaria and/or eczema,the number of patients with FeNO>25ppd,various indicators of pulmonary ventilation function,the number of patients with FEV1/FVC<80%and the number of patients with SAD(all P>0.05).2.4 Distribution of airway inflammatory phenotypes:80 cases(45.2%)of NEU type,46 cases(26.0%)of EOS type,30 cases(16.9%)of MIX type,21 cases(11.9%)of PAU type in AA group,49 cases(60.5%)of NEU type,12 cases(14.8%)of EOS type,8cases(9.9%)of MIX type,12 cases(14.8%)of PAU type in NAA group,the difference was statistically significant(χ~2=7.952,P=0.047).There were 16/21 patients in the AA group and 6/9 patients in the NAA group had at least one change in airway inflammation phenotypes after treatment.Conclusions:1.Compared with the CVA,CA has a younger age of onset,is more likely to be combined with rhinitis and or sinusitis,nasal polyps,and its type 2 inflammatory indexes are higher and pulmonary ventilation function is worse.2.Compared with the NAA,the age and onset age in AA group were younger,and is more likely to be combined with rhinitis and or sinusitis,nasal polyps,and its type 2inflammatory indexes are higher,and there was no difference in pulmonary ventilation function.3.Whether it is the CA,CVA,AA or NAA,the airway inflammatory phenotype is the most common with NEU type,among which CA,AA and NAA are followed by EOS type,PAU type and MIX type are rare,CVA is followed by PAU type,EOS type and MIX type are rare.4.The vast majority of asthma patients with different clinical phenotypes have an altered airway inflammatory phenotypes after treatment.