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High fractional exhaled nitric oxide and sputum eosinophils are associated with an increased risk of future virus‐induced exacerbations: A prospective cohort study

Summary Background The major trigger of asthma exacerbations is infection with a respiratory virus, most commonly rhinovirus. Type 2 inflammation is known to be associated with an increased risk of exacerbations in general. Whether type 2 inflammation at baseline increases the risk of future virus‐i...

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Published in:Clinical and experimental allergy 2017-08, Vol.47 (8), p.1007-1013
Main Authors: Bjerregaard, A., Laing, I. A., Backer, V., Sverrild, A., Khoo, S.‐K., Chidlow, G., Sikazwe, C., Smith, D. W., Le Souëf, P., Porsbjerg, C.
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container_issue 8
container_start_page 1007
container_title Clinical and experimental allergy
container_volume 47
creator Bjerregaard, A.
Laing, I. A.
Backer, V.
Sverrild, A.
Khoo, S.‐K.
Chidlow, G.
Sikazwe, C.
Smith, D. W.
Le Souëf, P.
Porsbjerg, C.
description Summary Background The major trigger of asthma exacerbations is infection with a respiratory virus, most commonly rhinovirus. Type 2 inflammation is known to be associated with an increased risk of exacerbations in general. Whether type 2 inflammation at baseline increases the risk of future virus‐induced exacerbations is unknown. Objective To assess whether type 2 inflammation is associated with an increased risk of virus‐induced exacerbations of asthma. Methods Stable asthmatics had spirometry, skin prick test, measurement of FeNO and sputum induced for differential cell counts. Patients were followed up for 18 months, during which they were assessed at the research unit when they had symptoms of an exacerbation. Nasal swabs collected at these assessments underwent viral detection by PCR. Results A total of 81 asthma patients were recruited, of which 22 (27%) experienced an exacerbation during the follow‐up period. Of these, 15 (68%) had a respiratory virus detected at exacerbation. Sputum eosinophils >1% at baseline increased the risk of having a subsequent virus‐induced exacerbation (HR 7.6 95% CI: 1.6‐35.2, P=.010) as did having FeNO >25 ppb (HR 3.4 95% CI: 1.1‐10.4, P=.033). Conclusion and Clinical Relevance Established type 2 inflammation during stable disease is a risk factor for virus‐induced exacerbations in a real‐life setting. Measures of type 2 inflammation, such as sputum eosinophils and FeNO, could be included in the risk assessment of patients with asthma in future studies.
doi_str_mv 10.1111/cea.12935
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A. ; Backer, V. ; Sverrild, A. ; Khoo, S.‐K. ; Chidlow, G. ; Sikazwe, C. ; Smith, D. W. ; Le Souëf, P. ; Porsbjerg, C.</creator><creatorcontrib>Bjerregaard, A. ; Laing, I. A. ; Backer, V. ; Sverrild, A. ; Khoo, S.‐K. ; Chidlow, G. ; Sikazwe, C. ; Smith, D. W. ; Le Souëf, P. ; Porsbjerg, C.</creatorcontrib><description>Summary Background The major trigger of asthma exacerbations is infection with a respiratory virus, most commonly rhinovirus. Type 2 inflammation is known to be associated with an increased risk of exacerbations in general. Whether type 2 inflammation at baseline increases the risk of future virus‐induced exacerbations is unknown. Objective To assess whether type 2 inflammation is associated with an increased risk of virus‐induced exacerbations of asthma. Methods Stable asthmatics had spirometry, skin prick test, measurement of FeNO and sputum induced for differential cell counts. Patients were followed up for 18 months, during which they were assessed at the research unit when they had symptoms of an exacerbation. Nasal swabs collected at these assessments underwent viral detection by PCR. Results A total of 81 asthma patients were recruited, of which 22 (27%) experienced an exacerbation during the follow‐up period. Of these, 15 (68%) had a respiratory virus detected at exacerbation. Sputum eosinophils &gt;1% at baseline increased the risk of having a subsequent virus‐induced exacerbation (HR 7.6 95% CI: 1.6‐35.2, P=.010) as did having FeNO &gt;25 ppb (HR 3.4 95% CI: 1.1‐10.4, P=.033). Conclusion and Clinical Relevance Established type 2 inflammation during stable disease is a risk factor for virus‐induced exacerbations in a real‐life setting. Measures of type 2 inflammation, such as sputum eosinophils and FeNO, could be included in the risk assessment of patients with asthma in future studies.</description><identifier>ISSN: 0954-7894</identifier><identifier>EISSN: 1365-2222</identifier><identifier>DOI: 10.1111/cea.12935</identifier><identifier>PMID: 28390083</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Asthma ; Asthma - metabolism ; Asthma - pathology ; Asthma - virology ; Breath Tests ; Cohort analysis ; eosinophils ; Eosinophils - metabolism ; Eosinophils - pathology ; exacerbation ; FeNO ; Health risks ; Humans ; Infections ; Inflammation ; Leukocytes (eosinophilic) ; Male ; Middle Aged ; Nitric oxide ; Nitric Oxide - metabolism ; Original ; ORIGINAL ARTICLES ; Polymerase chain reaction ; Prospective Studies ; Rhinovirus ; Risk assessment ; Risk factors ; Skin tests ; Sputum ; Sputum - metabolism ; Virus Diseases - metabolism ; Virus Diseases - pathology ; Viruses</subject><ispartof>Clinical and experimental allergy, 2017-08, Vol.47 (8), p.1007-1013</ispartof><rights>2017 John Wiley &amp; Sons Ltd</rights><rights>2017 John Wiley &amp; Sons Ltd.</rights><rights>Copyright © 2017 John Wiley &amp; Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4435-497e75da802569feff87c2af2a530077bb3d421e83612ee5e8e5d3557fc313ef3</citedby><cites>FETCH-LOGICAL-c4435-497e75da802569feff87c2af2a530077bb3d421e83612ee5e8e5d3557fc313ef3</cites><orcidid>0000-0001-8043-0171</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28390083$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bjerregaard, A.</creatorcontrib><creatorcontrib>Laing, I. A.</creatorcontrib><creatorcontrib>Backer, V.</creatorcontrib><creatorcontrib>Sverrild, A.</creatorcontrib><creatorcontrib>Khoo, S.‐K.</creatorcontrib><creatorcontrib>Chidlow, G.</creatorcontrib><creatorcontrib>Sikazwe, C.</creatorcontrib><creatorcontrib>Smith, D. W.</creatorcontrib><creatorcontrib>Le Souëf, P.</creatorcontrib><creatorcontrib>Porsbjerg, C.</creatorcontrib><title>High fractional exhaled nitric oxide and sputum eosinophils are associated with an increased risk of future virus‐induced exacerbations: A prospective cohort study</title><title>Clinical and experimental allergy</title><addtitle>Clin Exp Allergy</addtitle><description>Summary Background The major trigger of asthma exacerbations is infection with a respiratory virus, most commonly rhinovirus. Type 2 inflammation is known to be associated with an increased risk of exacerbations in general. Whether type 2 inflammation at baseline increases the risk of future virus‐induced exacerbations is unknown. Objective To assess whether type 2 inflammation is associated with an increased risk of virus‐induced exacerbations of asthma. Methods Stable asthmatics had spirometry, skin prick test, measurement of FeNO and sputum induced for differential cell counts. Patients were followed up for 18 months, during which they were assessed at the research unit when they had symptoms of an exacerbation. Nasal swabs collected at these assessments underwent viral detection by PCR. Results A total of 81 asthma patients were recruited, of which 22 (27%) experienced an exacerbation during the follow‐up period. Of these, 15 (68%) had a respiratory virus detected at exacerbation. Sputum eosinophils &gt;1% at baseline increased the risk of having a subsequent virus‐induced exacerbation (HR 7.6 95% CI: 1.6‐35.2, P=.010) as did having FeNO &gt;25 ppb (HR 3.4 95% CI: 1.1‐10.4, P=.033). Conclusion and Clinical Relevance Established type 2 inflammation during stable disease is a risk factor for virus‐induced exacerbations in a real‐life setting. 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W.</creatorcontrib><creatorcontrib>Le Souëf, P.</creatorcontrib><creatorcontrib>Porsbjerg, C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical and experimental allergy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bjerregaard, A.</au><au>Laing, I. A.</au><au>Backer, V.</au><au>Sverrild, A.</au><au>Khoo, S.‐K.</au><au>Chidlow, G.</au><au>Sikazwe, C.</au><au>Smith, D. W.</au><au>Le Souëf, P.</au><au>Porsbjerg, C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High fractional exhaled nitric oxide and sputum eosinophils are associated with an increased risk of future virus‐induced exacerbations: A prospective cohort study</atitle><jtitle>Clinical and experimental allergy</jtitle><addtitle>Clin Exp Allergy</addtitle><date>2017-08</date><risdate>2017</risdate><volume>47</volume><issue>8</issue><spage>1007</spage><epage>1013</epage><pages>1007-1013</pages><issn>0954-7894</issn><eissn>1365-2222</eissn><abstract>Summary Background The major trigger of asthma exacerbations is infection with a respiratory virus, most commonly rhinovirus. Type 2 inflammation is known to be associated with an increased risk of exacerbations in general. Whether type 2 inflammation at baseline increases the risk of future virus‐induced exacerbations is unknown. Objective To assess whether type 2 inflammation is associated with an increased risk of virus‐induced exacerbations of asthma. Methods Stable asthmatics had spirometry, skin prick test, measurement of FeNO and sputum induced for differential cell counts. Patients were followed up for 18 months, during which they were assessed at the research unit when they had symptoms of an exacerbation. Nasal swabs collected at these assessments underwent viral detection by PCR. Results A total of 81 asthma patients were recruited, of which 22 (27%) experienced an exacerbation during the follow‐up period. Of these, 15 (68%) had a respiratory virus detected at exacerbation. Sputum eosinophils &gt;1% at baseline increased the risk of having a subsequent virus‐induced exacerbation (HR 7.6 95% CI: 1.6‐35.2, P=.010) as did having FeNO &gt;25 ppb (HR 3.4 95% CI: 1.1‐10.4, P=.033). Conclusion and Clinical Relevance Established type 2 inflammation during stable disease is a risk factor for virus‐induced exacerbations in a real‐life setting. Measures of type 2 inflammation, such as sputum eosinophils and FeNO, could be included in the risk assessment of patients with asthma in future studies.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28390083</pmid><doi>10.1111/cea.12935</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-8043-0171</orcidid><oa>free_for_read</oa></addata></record>
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language eng
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source Wiley
subjects Adult
Asthma
Asthma - metabolism
Asthma - pathology
Asthma - virology
Breath Tests
Cohort analysis
eosinophils
Eosinophils - metabolism
Eosinophils - pathology
exacerbation
FeNO
Health risks
Humans
Infections
Inflammation
Leukocytes (eosinophilic)
Male
Middle Aged
Nitric oxide
Nitric Oxide - metabolism
Original
ORIGINAL ARTICLES
Polymerase chain reaction
Prospective Studies
Rhinovirus
Risk assessment
Risk factors
Skin tests
Sputum
Sputum - metabolism
Virus Diseases - metabolism
Virus Diseases - pathology
Viruses
title High fractional exhaled nitric oxide and sputum eosinophils are associated with an increased risk of future virus‐induced exacerbations: A prospective cohort study
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