How reliably can algorithms identify eosinophilic asthma phenotypes using non-invasive biomarkers?

Abstract

Background and aims: Asthma is a heterogeneous respiratory disease that encompasses different inflammatory and functional endophenotypes. Many non-invasive biomarkers has been investigated to its pathobiology. Heany et al proposed a clinical algorithm that classifies severe asthmatic patients into likely-eosinophilic phenotypes, based on accessible biomarkers: PBE, current treatment, FeNO, presence of nasal polyps (NP) and age of onset.

Materials and methods: We assessed the concordance between the algorithm proposed by Heany et al. with sputum examination, the gold standard, in 145 asthmatic patients of the MEGA cohort with varying grades of severity.

Results: No correlation was found between both classifications 0.025 (CI = 0.013-0.037). Moreover, no relationship was found between sputum eosinophilia and peripheral blood eosinophilia count in the total studied population.

Discussion and conclusion: In conclusion, our results suggest that grouping the biomarkers proposed by Heany et al. are insufficient to diagnose eosinophilic phenotypes in asthmatic patients. Sputum analysis remains the gold standard to assess airway inflammation.

Keywords: asthma; biomarkers; eosinophils; exhaled nitric oxide; non‐eosinophilic; phenotypes; sputum.

Conflict of interest statement

Dr. Betancor is supported by a Rio Hortega Research Contract from Instituto Carlos III, Spanish Ministry of Science. Dr. Valverde has received lecturing fees from GSK and sits on the advisory board for Organon. Dr. Rial reports receiving personal fees from GSK, Allergy Therapeutics, and AstraZeneca outside the submitted work. Dr. González Barcala reports personal fees from ALK, AstraZeneca, Bial, Boehringer Ingelheim, Chiesi, Gebro Pharma, GlaxoSmithKline, Laboratorios Esteve, Menarini, Mundipharma, Novartis, Rovi, Roxall, Stallergenes‐Greer, Teva, as well as grants from Mundipharma outside the submitted work. Dr. Quirce reports personal fees from AstraZeneca, Novartis, Sanofi, Boehringer Ingelheim, Teva, ALK, Mundipharma, GSK, Chiesi, and Leti outside the submitted work. Dr. Soto reports non‐financial support from CIBER de Enfermedades Respiratorias (CIBERES) during the conduct of the study; outside of the present work, she reports personal fees from Stallergennes‐Greer, Menarini, and Novartis, personal fees from GSK, Hal Allergy, Allergy Therapeutics, AstraZeneca, and grants from Sociedad Española de Alergología e Inmunología Clínica SEAIC and Sociedad Española de Neumología y Cirugía Torácica SEPAR. Dr. Martinez Rivera reports having received grants and personal fees from AstraZeneca, Teva, GSK, Novartis, and Mundipharma outside the submitted work. Dr. Munoz reports personal fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Teva, Mundifarma, Chiesi, and Faes outside the submitted work. Dr. Sastre reports grants and personal fees from Sanofi, GSK, Novartis, AstraZeneca, Mundipharma, and Faes Farma outside the submitted work. Dr. Olaguibel reports grants from Sanofi and/or personal fees from AstraZeneca and Mundipharma outside the submitted work. Dr. Plaza reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, Merck, Chiesi, Novartis, Menarini, and Sanofi outside the submitted work. Dr. Mullol reports personal and other fees from Sanofi‐Genzyme & Regeneron, Novartis, Viatris (Mylan pharma), Uriach group, Mitsubishi‐Tanabe, Menarini, UCB, AstraZeneca, GSK, and MSD outside the submitted work. Dr. del Pozo reports personal and other fees from Sanofi, AstraZeneca, and GSK outside the submitted work. All other authors have no conflicts of interest.

© 2022 The Authors. Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.

Figures

FIGURE 1

Concordance between values of eosinophils in sputum and Heany et al grades