Characteristics and Burden of Type 2-High Severe Asthma With Bronchiectasis

In patients with type 2-high severe asthma (T2-SA), type 2 inflammation may contribute to the development of bronchiectasis, and the combination of T2-SA and bronchiectasis may be associated with more chronic mucus hypersecretion (CMH) as well as more chronic medication intake and annual exacerbations compared with T2-SA alone. This is according to findings from an observational study published in the Journal of Allergy.

The researchers of the study analyzed the clinical and functional differences between patients with T2-SA and bronchiectasis vs patients with T2-SA but without bronchiectasis. The study cohort included patients (mean age, 55±11 years; 59.3% female) from 2 Italian severe asthma-dedicated outpatient services. A total of 50 patients had coexisting bronchiectasis (mean age, 55.5 years) and 63 patients had T2-SA alone (mean age, 54.9 years).

Patients with T2-SA and bronchiectasis more often had chronic rhinosinusitis (CRS) (84% vs 58.7%; P =.004) and chronic rhinosinusitis with nasal polyps (CRSwNP) (54% vs 42.9%; P =.0165). In addition, patients with bronchiectasis reported significantly more CMH than those without bronchiectasis (58% vs 23.8%, respectively; P =.0004). Patients with T2-SA and bronchiectasis were also more frequently on chronic oral corticosteroids (OCS) (56% vs 34.9%; P =.0357) and had a higher median number of exacerbations in the previous year (10 vs 6; P =.0487).

According to a multivariate logistic regression model, the presence of bronchiectasis was significantly associated with CRS, CMH, and daily OCS intake. The accuracy of this model was 78% (95% CI, 69-88), with a sensibility of 74% and a specificity of 76%.

The researchers noted that the primary study limitations were the absence of data on sputum cytology and the lack of induced sputum. Additionally, the retrospective assessment of asthma exacerbations may have limited the research.

The researchers concluded that type 2 inflammation could have a causative role in bronchiectasis development and that early detection of bronchiectasis may be important for improving T2-SA outcomes. Investigators further noted that a high-resolution chest computed tomography scan is recommended at time of T2-SA diagnosis, particularly “in patients with CRS who report frequent asthma exacerbations, chronic sputum production and OCS dependency.” This may facilitate earlier detection of bronchiectasis, which “can be crucial to provide adequate treatment, necessary to improve and control patients’ respiratory symptoms and quality of life.”

Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.

Reference

Crimi C, Campisi R, Nolasco S, et al. Type 2-high severe asthma with and without bronchiectasis: A prospective observational multicentre study. J Asthma Allergy. 2021;14:1441-1452. doi:10.2147/JAA.S332245