TY - JOUR
T1 - Eosinophilic Granulomatosis With Polyangiitis
T2 - Clinical Predictors of Long-term Asthma Severity
AU - Berti, Alvise
AU - Cornec, Divi
AU - Casal Moura, Marta
AU - Smyth, Robert J.
AU - Dagna, Lorenzo
AU - Specks, Ulrich
AU - Keogh, Karina A.
N1 - Funding Information:
Author Contributions: A. B. D. C. M. C. M. and R. J. S. acquired the data. A. B. and K. A. K. conceived the study, and A. B. D. C. L. D. and U. S. designed the study. A. B. and K. A. K. had full access to all of the data in the study and take responsibility for the integrity of the data; A. B. takes responsibility for the accuracy of the data analysis and drafted the article. A. B. confirms that the study objectives and procedures are honestly disclosed; he has reviewed the study execution data and confirms that procedures were followed to an extent that convinces all authors that the results are valid and generalizable to a population similar to that enrolled in this study. All the authors were involved in the writing and editing of the manuscript and approved the final version to be published. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: A. B. received fellowship grants from VCRC (Vasculitis Clinical Research Consortium). D. C. received fellowship grants from the French Society of Rheumatology and from Brest University Hospital, France. None declared (M. C. M. R. J. S. L. D. U. S. K. A. K.). Other contributions: We thank Francesca Dallago for her contribution to production of figures. Additional information: The e-Figures and e-Tables can be found in the Supplemental Materials section of the online article. FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.
Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: A. B. received fellowship grants from VCRC (Vasculitis Clinical Research Consortium). D. C. received fellowship grants from the French Society of Rheumatology and from Brest University Hospital, France. None declared (M. C. M., R. J. S., L. D., U. S., K. A. K.).
Publisher Copyright:
© 2020 American College of Chest Physicians
PY - 2020/5
Y1 - 2020/5
N2 - Background: The long-term clinical course of asthma in patients with eosinophilic granulomatosis with polyangiitis (EGPA) remains unclear. We aimed to characterize long-term asthma in EGPA and to identify baseline predictors of long-term asthma severity. Methods: This retrospective cohort study included patients who fulfilled standardized criteria for EGPA who were followed up in a single referral center between 1990 and 2017. Baseline and 3 (± 1) years of follow-up clinical, laboratory, and pulmonary function data were analyzed. Results: Eighty-nine patients with EGPA and a documented asthma assessment at baseline and at 3 years from diagnosis were included. Severe/uncontrolled asthma was observed in 42.7% of patients at diagnosis and was associated with previous history of respiratory allergy (P < .01), elevated serum total IgE levels (P < .05), and increased use of high-dose inhaled corticosteroids (ICSs; P < .05) and oral corticosteroids (OCSs; P < .001) for respiratory symptoms the year before the EGPA diagnosis. During follow-up, an improvement or worsening in asthma severity was noted in 12.3% and 10.1% of patients, respectively. Severe/uncontrolled asthma was present in 40.5% of patients at 3 years and was associated with increased airway resistance on pulmonary function tests (PFTs; P < .05). Long-term PFTs did not improve during long-term follow-up regardless of ICS or OCS therapy. Multivariate binary logistic regression results indicated that severe rhinosinusitis (P = .038), pulmonary infiltrates (P = .011), overweight (BMI ≥ 25 kg/m2; P = .041), and severe/uncontrolled asthma at vasculitis diagnosis (P < .001) independently predicted severe/uncontrolled asthma at the 3-year end point. Conclusions: In patients with asthma with EGPA, long-term severe/uncontrolled asthma is associated with baseline pulmonary and ear, nose, and throat manifestations but not with clear-cut vasculitic features.
AB - Background: The long-term clinical course of asthma in patients with eosinophilic granulomatosis with polyangiitis (EGPA) remains unclear. We aimed to characterize long-term asthma in EGPA and to identify baseline predictors of long-term asthma severity. Methods: This retrospective cohort study included patients who fulfilled standardized criteria for EGPA who were followed up in a single referral center between 1990 and 2017. Baseline and 3 (± 1) years of follow-up clinical, laboratory, and pulmonary function data were analyzed. Results: Eighty-nine patients with EGPA and a documented asthma assessment at baseline and at 3 years from diagnosis were included. Severe/uncontrolled asthma was observed in 42.7% of patients at diagnosis and was associated with previous history of respiratory allergy (P < .01), elevated serum total IgE levels (P < .05), and increased use of high-dose inhaled corticosteroids (ICSs; P < .05) and oral corticosteroids (OCSs; P < .001) for respiratory symptoms the year before the EGPA diagnosis. During follow-up, an improvement or worsening in asthma severity was noted in 12.3% and 10.1% of patients, respectively. Severe/uncontrolled asthma was present in 40.5% of patients at 3 years and was associated with increased airway resistance on pulmonary function tests (PFTs; P < .05). Long-term PFTs did not improve during long-term follow-up regardless of ICS or OCS therapy. Multivariate binary logistic regression results indicated that severe rhinosinusitis (P = .038), pulmonary infiltrates (P = .011), overweight (BMI ≥ 25 kg/m2; P = .041), and severe/uncontrolled asthma at vasculitis diagnosis (P < .001) independently predicted severe/uncontrolled asthma at the 3-year end point. Conclusions: In patients with asthma with EGPA, long-term severe/uncontrolled asthma is associated with baseline pulmonary and ear, nose, and throat manifestations but not with clear-cut vasculitic features.
KW - ANCA-associated vasculitis
KW - Churg-Strauss
KW - EGPA
KW - asthma
KW - eosinophilic granulomatosis with polyangiitis
KW - severe/uncontrolled asthma
UR - http://www.scopus.com/inward/record.url?scp=85083673647&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85083673647&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2019.11.045
DO - 10.1016/j.chest.2019.11.045
M3 - Article
C2 - 31958440
AN - SCOPUS:85083673647
VL - 157
SP - 1086
EP - 1099
JO - Diseases of the chest
JF - Diseases of the chest
SN - 0012-3692
IS - 5
ER -