Eosinophilic Granulomatosis With Polyangiitis: Clinical Predictors of Long-term Asthma Severity

Alvise Berti; Divi Cornec; Marta Casal Moura; Robert J Smyth; Lorenzo Dagna; Ulrich Specks; Karina A Keogh

doi:10.1016/j.chest.2019.11.045

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Eosinophilic Granulomatosis With Polyangiitis: Clinical Predictors of Long-term Asthma Severity

Journal article

Peer reviewed

Eosinophilic Granulomatosis With Polyangiitis: Clinical Predictors of Long-term Asthma Severity

Alvise Berti, Divi Cornec, Marta Casal Moura, Robert J Smyth, Lorenzo Dagna, Ulrich Specks and Karina A Keogh

Chest, Vol.157(5), pp.1086-1099

05/2020

DOI: 10.1016/j.chest.2019.11.045

PMID: 31958440

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https://www.sciencedirect.com/science/article/abs/pii/S0012369220300234?via=ihubView

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Abstract

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. 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. 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/m ; P = .041), and severe/uncontrolled asthma at vasculitis diagnosis (P < .001) independently predicted severe/uncontrolled asthma at the 3-year end point. 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.

Asthma - complications

Asthma - physiopathology

Eosinophilia - complications

Female

Granulomatosis with Polyangiitis - complications

Humans

Male

Middle Aged

Retrospective Studies

Risk Factors

Severity of Illness Index

Details

Title: Subtitle: Eosinophilic Granulomatosis With Polyangiitis: Clinical Predictors of Long-term Asthma Severity
Creators: Alvise Berti - Ospedale Santa Chiara
Divi Cornec - Université de Bretagne Occidentale
Marta Casal Moura - Mayo Clinic
Robert J Smyth - Boston Medical Center
Lorenzo Dagna - Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milan, Italy
Ulrich Specks - Mayo Clinic
Karina A Keogh - Mayo Clinic
Resource Type: Journal article
Publication Details: Chest, Vol.157(5), pp.1086-1099
DOI: 10.1016/j.chest.2019.11.045
PMID: 31958440
NLM abbreviation: Chest
ISSN: 0012-3692
eISSN: 1931-3543
Language: English
Date published: 05/2020
Academic Unit: Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
Record Identifier: 9984695835702771

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