Certain subphenotypes of aspirin-exacerbated respiratory disease distinguished by latent class analysis

• Published in: Journal of allergy and clinical immunology Vol. 133; no. 1; pp. 98 - 103.e6
• Main Authors: Bochenek, Grazyna, MD, PhD, Kuschill-Dziurda, Joanna, MD, Szafraniec, Krystyna, PhD, Plutecka, Hanna, PhD, Szczeklik, Andrzej, MD, PhD, Nizankowska-Mogilnicka, Ewa, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.01.2014; Elsevier; Elsevier Limited
• Subjects: Adult; Airway Obstruction - complications; Airway Obstruction - diagnosis; Allergy and Immunology; Aspirin; aspirin-exacerbated respiratory disease; Asthma; asthma phenotype; Asthma, Aspirin-Induced - classification; Asthma, Aspirin-Induced - complications; Asthma, Aspirin-Induced - diagnosis; Biological and medical sciences; Body mass index; Cell Movement; Chronic obstructive pulmonary disease, asthma; Eosinophils - pathology; Family medical history; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hospitalization; Humans; Immunopathology; Laboratories; latent class analysis; Leukotriene E4 - urine; Male; Medical sciences; Middle Aged; Nasal Polyps - complications; Nasal Polyps - diagnosis; Nonsteroidal anti-inflammatory drugs; Pneumology; Probability; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Sinusitis - complications; Sinusitis - diagnosis; Skin; Spirometry; Statistics as Topic; Variables; nonsteroidal anti-inflammatory drugs; TENOR; National Asthma Education and Prevention Program Expert Panel Report 3; Aspirin; Cysteinyl leukotriene; NSAID; aspirin-exacerbated respiratory disease; LTE 4; AERD; latent class analysis; LCA; cysLT; Intensive care unit; NAEPP EPR3; asthma phenotype; Emergency department; The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens; Nonsteroidal anti-inflammatory drug; ICU; ED; Leukotriene E 4; LTE4; Lung disease; Prostaglandin-endoperoxide synthase; Immunopathology; Enzyme; Respiratory disease; Enzyme inhibitor; Acetylsalicylic acid; Antiplatelet agent; Asthma; Non steroidal antiinflammatory agent; Phenotype; Immunology; Bronchus disease; Obstructive pulmonary disease; Oxidoreductases; Salicylates; Aspirin-exacerbated respiratory disease; Leukotriene E; Latent class analysis; LTE
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2013.07.004

Background Aspirin-exacerbated respiratory disease (AERD) is recognized as a distinct asthma phenotype. It usually has a severe course accompanied by chronic hyperplastic eosinophilic sinusitis with nasal polyps, blood eosinophilia, and increased concentrations of urinary leukotriene E4 (LTE4 ). More insightful analysis of individual patients shows this group to be nonhomogeneous. Objective We sought to identify any likely subphenotypes in a cohort of patients with AERD through the application of latent class analysis (LCA). Methods Clinical data from 201 patients with AERD (134 women) were collected from questionnaires. Standard spirometry, atopy traits, blood eosinophilia, and urinary LTE4 concentrations were evaluated. LCA was applied to identify possible AERD subphenotypes. Results Four classes (subphenotypes) within the AERD phenotype were identified as follows: class 1, asthma with a moderate course, intensive upper airway symptoms, and blood eosinophilia (18.9% of patients); class 2, asthma with a mild course, relatively well controlled, and with low health care use (34.8% of patients); class 3, asthma with a severe course, poorly controlled, and with severe exacerbations and airway obstruction (41.3% of patients); and class 4, poorly controlled asthma with frequent and severe exacerbations in female subjects (5.0% of patients). Atopic status did not affect class membership. Patients with particularly intensive upper airway symptoms had the highest levels of blood eosinophilia and the highest concentrations of urinary LTE4. Conclusions LCA revealed unique AERD subphenotypes, thus corroborating the heterogeneity of this population. Such discrimination might facilitate more individualized treatment in difficult-to-treat patients.