Three-year Prognosis of Asthma Phenotypes in Japan

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Abstract RATIONALE: This nationwide multicenter clinical study was conducted to clarify the difference in 3-year prognosis among five asthma phenotypes in Japan.METHODS: Adult asthma patients were enrolled and classified into five phenotypes according to the decision tree established in the previous NHOM-Asthma study; i.e., phenotype 1 (P1): Late-onset, old, less atopic; phenotype 2 (P2): Late-onset, old, eosinophilic, low FEV1; phenotype 3 (P3): Early-onset, long-duration, atopic, poorly controlled; phenotype 4 (P4): Early-onset, young, female-dominant, atopic; and phenotype 5 (P5): Female-dominant, T2-low, most severe. Clinical data including pulmonary function test, FeNO, blood eosinophils, total IgE, asthma medications, and patient-reported outcomes (PROs) were collected annually for 3 years. Asthma-related prognosis as determined by annual acute exacerbations, time to first exacerbation, FEV1, FeNO, and PROs, was compared among the five phenotypes. Transition between asthma phenotypes was also analyzed.RESULTS: A total of 1,739 asthma patients were enrolled and classified into P1 (n=376), P2 (n=226), P3 (n=568), P4 (n=249) and P5 (n=40). The highest cumulative number of exacerbations was observed in P5, with 3.62 in 3 years; P1 had the lowest cumulative number of exacerbations. P4 showed a slight decrease and P2 showed a slight increase in FEV1 over 3 years. P2 had the highest FeNO at baseline which decreased from 57.8 (SD 52.6) to 44.7 (SD 40.8) ppb over 3 years. ACQ6 was improved in P2 and P4 over 3 years. While most patients remained within their baseline phenotypes in P1 (78.7%), P3 (92.6%), and P4 (81.8%), only 51.2% in P2 and 23.3% in P5 remained within their baseline phenotypes.CONCLUSIONS: There were differences in prognosis among five asthma phenotypes in Japan. Asthma patients with early-onset phenotypes tended to remain in these phenotypes.

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