Influence of sex, cigarette smoking and airway inflammation on treatable traits in CBIOPRED severe asthma

• Published in: Clinical and translational allergy 2022-09, Vol.12 (9), p.e12189-n/a
• Main Authors: Dong, Cong, Yang, Xiaojing, Luo, Wei, Fan, Ethan, Assam, Nkouibert Pryseley, Kang, Jian, Zhang, Yunhui, Huang, Mao, Xu, Jinfu, Huang, Kewu, Li, Qiang, Zhang, Xiangyan, Zhao, Jianping, Liu, Xiaoxia, Sun, Shenghua, Tang, Huaping, He, Bei, Cai, Shaoxi, Chen, Ping, Wei, Chunhua, Wang, Guangfa, Xie, Lixin, Lin, Jiangtao, Tang, Yuling, Han, Zhihai, Fu, Xiuhua, Wang, Changzheng, Shen, Huahao, Jin, Meiling, Zhu, Lei, Shi, Guochao, Qiu, Zhongmin, Wen, Zhongguang, Gu, Wei, Chung, Kian Fan, Zhang, Qingling, Zhong, Nanshan
• Format: Article
• Language: English
• Subjects: Asthma; baseline and longitudinal; Chen, Ping; Conflicts of interest; Editing; Females; gender; Gender differences; Hormone replacement therapy; Inflammation; Influence; Letter; Menopause; Neutrophils; Nitric oxide; Quality of life; Questionnaires; severe asthma; Smoking; Steroids; Womens health; Writing
• ISSN: 2045-7022; 2045-7022
• DOI: 10.1002/clt2.12189

To the Editor Asthma presents a major public health challenge in China, where it affects 45.7 million adults with an estimated prevalence of 4.2%; 26.2% of adults with asthma have airflow limitation. 1 Severe asthma is recognised in China with the recent publication of an expert consensus guidelines for the diagnosis and management of severe asthma. 2 Severe asthma has been defined as asthma that requires treatment with high dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming “uncontrolled” or that remains “uncontrolled” despite this therapy. 3 More recently, the identification of a higher number of treatable traits in severe asthma compared to mild-moderate asthma has facilitated a strategy for the management of airways disease. 4 However, the influence of various factors on the major treatable traits such as airflow obstruction and exacerbations is unclear. [...]we examined the role of sex and cigarette smoking on these traits and also their link to airway inflammation measured by inflammatory cell counts in induced sputum samples. There was no difference in the Asthma Control Questionnaire (ACQ) and total questionnaire of asthma quality of life in adults (AQLQ) scores apart from activity limitation score being lowest in ESA (Supplementary Table S2). Currently-smoking severe asthma patients subjects had lower eosinophilic inflammation, likely to be a suppressive effect of current smoking, with higher sputum neutrophilia. 9 However, the degree of neutrophilia was related to airflow obstruction in NSA as previously reported. 10 Interestingly, the level of eosinophilic inflammation was correlated with the number of exacerbations in the previous year, supporting its link with Type-2 inflammation. 11 In the C-BIOPRED cohort, we have shown that sex differences and the effect of smoking are important influences on the treatable traits of severe asthma, with a likelihood of improvement in females at 1 year follow-up and lower type-2 inflammatory markers in currently-smoking asthmatics.