Baseline variables predictive of long-term severe/uncontrolled asthma in patients with eosinophilic granulomatosis with polyangiitis (EGPA) include the presence of severe rhinosinusitis, being overweight, the presence of pulmonary infiltrates, and having severe/uncontrolled asthma at vasculitis diagnosis, according to study results published in CHEST.
The study was a retrospective analysis of patients who fulfilled ≥1 of 3 standardized EGPA classification criteria (n=89). All patients were followed in a single referral center between 1990 and 2017, and only patients with baseline and 3 years of follow-up clinical, laboratory, and pulmonary function data were included. Severe/uncontrolled asthma, allergic asthma and/or rhinitis/rhinosinusitis, vasculitis manifestations, and systemic/vasculitis relapse were disease-related variables included in the analysis.
At time of diagnosis, severe/uncontrolled asthma was reported in 42.7% of patients. The presence of severe/uncontrolled asthma at diagnosis was associated with prior history of respiratory allergy (P <.003), elevated serum total immunoglobulin E levels (P <.017), increased use of high-dose inhaled corticosteroids (P =.025), and oral corticosteroids (P <.001).
At 3 years, 40.5% of patients had severe/uncontrolled asthma, which was associated with increased airway resistance on pulmonary function testing (P <.05).
An improvement in asthma was observed in 12.3% of patients during follow-up and 10.1% of patients had worsening asthma during this period.
Baseline variables predictive of severe/uncontrolled asthma at 3-year follow-up included severe rhinosinusitis (odds ratio [OR], 3.57; 95% CI, 1.07-13.55; P =.038), pulmonary infiltrates (OR, 5.16; 95% CI, 1.43-21.85; P =.011), overweight (OR, 3.41; 95% CI, 1.05-12.90; P =.041), and severe/uncontrolled asthma at baseline (OR, 10.64; 95% CI, 3.43-39.08; P <.001).
Study limitations included the retrospective nature as well as the lack of data on treatment compliance and cumulative dosage of oral corticosteroids.
“All of these findings highlight the importance of the question of how to optimize asthma treatment in EGPA patients, and the need to identify early predictors of long-term asthma severity,” the researchers wrote.
Berti A, Cornec D, Moura MC, et al. Eosinophilic granulomatosis with polyangiitis: clinical predictors of long-term asthma severity [published online January 17, 2020]. CHEST. doi:10.1016/j.chest.2019.11.045