Heterogeneity of Paucigranulocytic Asthma: A Prospective Cohort Study with Hierarchical Cluster Analysis.

Deng, K; Zhang, X; Liu, Y; Zhang, L; Wang, G; Feng, M; Oliver, BG; Wang, L; Hansbro, PM; Qin, L; Xie, M; Chen, ZH; Simpson, J; Zhang, J; Li, WM; Wang, G; Gibson, PG

Heterogeneity of Paucigranulocytic Asthma: A Prospective Cohort Study with Hierarchical Cluster Analysis.

Deng, K Zhang, X Liu, Y Zhang, L Wang, G Feng, M Oliver, BG Wang, L Hansbro, PM Qin, L Xie, M Chen, ZH Simpson, J Zhang, J Li, WM Wang, G Gibson, PG

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Publisher:: ELSEVIER
Publication Type:: Journal Article
Citation:: J Allergy Clin Immunol Pract, 2021, 9, (6), pp. 2344-2355
Issue Date:: 2021-06

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Field	Value	Language
dc.contributor.author	Deng, K
dc.contributor.author	Zhang, X
dc.contributor.author	Liu, Y
dc.contributor.author	Zhang, L
dc.contributor.author	Wang, G
dc.contributor.author	Feng, M
dc.contributor.author	Oliver, BG
dc.contributor.author	Wang, L
dc.contributor.author	Hansbro, PM
dc.contributor.author	Qin, L
dc.contributor.author	Xie, M
dc.contributor.author	Chen, ZH
dc.contributor.author	Simpson, J
dc.contributor.author	Zhang, J
dc.contributor.author	Li, WM
dc.contributor.author	Wang, G
dc.contributor.author	Gibson, PG
dc.date.accessioned	2022-03-25T05:27:28Z
dc.date.available	2021-01-04
dc.date.available	2022-03-25T05:27:28Z
dc.date.issued	2021-06
dc.identifier.citation	J Allergy Clin Immunol Pract, 2021, 9, (6), pp. 2344-2355
dc.identifier.issn	2213-2198
dc.identifier.issn	2213-2201
dc.identifier.uri	http://hdl.handle.net/10453/155580
dc.description.abstract	BACKGROUND: Asthma, a heterogeneous disease, can be divided into 4 inflammatory phenotypes using induced sputum cell counts-eosinophilic asthma (EA), neutrophilic asthma (NA), mixed granulocytic asthma, and paucigranulocytic asthma (PGA). Although research has focused on EA and NA, there is little known about PGA. OBJECTIVE: To study the heterogeneity of PGA and identify possible PGA clusters to guide clinical treatment. METHODS: Patients with PGA were grouped by hierarchical cluster analysis and enrolled into a prospective cohort study to validate the clusters, relative to future risk of asthma exacerbations in a real-world setting. Clusters were validated by tree analysis in a separate population. Finally, we explored PGA stability. RESULTS: Cluster analysis of 145 patients with PGA identified 3 clusters: cluster 1 (n = 110, 75.9%) was "mild PGA," cluster 2 (n = 20, 13.8%) was "PGA with psychological dysfunction and rhinoconjunctivitis and other allergic diseases," and cluster 3 (n = 15, 10.3%) was "smoking-associated PGA." Cluster 3 had significantly increased risk of severe exacerbation (relative risk [RR] = 6.43, P = .01), emergency visit (RR = 8.61, P = .03), and hospitalization (RR = 12.94, P < .01). Results of the cluster analysis were successfully validated in an independent PGA population classified using decision tree analysis. Although PGA can transform into or develop from other phenotypes, 70% were stable over time. CONCLUSIONS: Among 3 identified PGA clusters, cluster 3 had a higher risk of severe exacerbation. PGA heterogeneity indicates the requirement of novel targeted interventions.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	ELSEVIER
dc.relation.ispartof	J Allergy Clin Immunol Pract
dc.relation.isbasedon	10.1016/j.jaip.2021.01.004
dc.rights	info:eu-repo/semantics/embargoedAccess
dc.subject.mesh	Asthma
dc.subject.mesh	Cluster Analysis
dc.subject.mesh	Humans
dc.subject.mesh	Phenotype
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Sputum
dc.subject.mesh	Sputum
dc.subject.mesh	Humans
dc.subject.mesh	Asthma
dc.subject.mesh	Cluster Analysis
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Phenotype
dc.title	Heterogeneity of Paucigranulocytic Asthma: A Prospective Cohort Study with Hierarchical Cluster Analysis.
dc.type	Journal Article
utslib.citation.volume	9
utslib.location.activity	United States
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Science
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	/University of Technology Sydney/Faculty of Science/School of Life Sciences
pubs.organisational-group	/University of Technology Sydney/Centre for Health Technologies (CHT)
utslib.copyright.status	open_access	*
utslib.copyright.embargo	2022-06-01T00:00:00+1000Z
dc.date.updated	2022-03-25T05:27:27Z
pubs.issue	6
pubs.publication-status	Published
pubs.volume	9
utslib.citation.issue	6

Abstract:

BACKGROUND: Asthma, a heterogeneous disease, can be divided into 4 inflammatory phenotypes using induced sputum cell counts-eosinophilic asthma (EA), neutrophilic asthma (NA), mixed granulocytic asthma, and paucigranulocytic asthma (PGA). Although research has focused on EA and NA, there is little known about PGA. OBJECTIVE: To study the heterogeneity of PGA and identify possible PGA clusters to guide clinical treatment. METHODS: Patients with PGA were grouped by hierarchical cluster analysis and enrolled into a prospective cohort study to validate the clusters, relative to future risk of asthma exacerbations in a real-world setting. Clusters were validated by tree analysis in a separate population. Finally, we explored PGA stability. RESULTS: Cluster analysis of 145 patients with PGA identified 3 clusters: cluster 1 (n = 110, 75.9%) was "mild PGA," cluster 2 (n = 20, 13.8%) was "PGA with psychological dysfunction and rhinoconjunctivitis and other allergic diseases," and cluster 3 (n = 15, 10.3%) was "smoking-associated PGA." Cluster 3 had significantly increased risk of severe exacerbation (relative risk [RR] = 6.43, P = .01), emergency visit (RR = 8.61, P = .03), and hospitalization (RR = 12.94, P < .01). Results of the cluster analysis were successfully validated in an independent PGA population classified using decision tree analysis. Although PGA can transform into or develop from other phenotypes, 70% were stable over time. CONCLUSIONS: Among 3 identified PGA clusters, cluster 3 had a higher risk of severe exacerbation. PGA heterogeneity indicates the requirement of novel targeted interventions.

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http://hdl.handle.net/10453/155580