Identification of asthma phenotypes based on extrapulmonary treatable traits
Patrícia Freitas, Rafaella Fagundes Xavier, Vanessa M. McDonald, Peter G. Gibson, Laura Cordova‐Rivera, Karina Couto Furlanetto, Joice Mara de Oliveira, Regina Maria Carvalho‐Pinto, Alberto Cukier, Rafaël Stelmach, Celso Ricardo Fernandes Carvalho
Abstract
Asthma is a heterogeneous disease and the description of asthma phenotypes based on extrapulmonary traits has not been previously reported. <b>Aim:</b> to identify and characterise clusters based on clinical, functional, anthropometrical, and psychological characteristics in adults with moderate-to-severe asthma. <b>Methods:</b> This is a cross-sectional multi-centre study involving centres in Brazil and Australia. Subjects (N=296) with asthma were consecutively recruited. Physical activity level (PAL), clinical control (ACQ), anthropometric data, lung function, psychological (HADS) and health status (AQLQ) were evaluated. Patients were classified by hierarchical cluster analysis and the comparison between clusters was performed by ANOVA, Kruskal-Wallis and Chi-square tests. Multiple logistic and linear regression models were performed to evaluate the association between variables. <b>Results:</b> Four clusters were identified: (1) controlled asthma who were physically active; (2) uncontrolled asthma who were physically inactive and sedentary; (3) uncontrolled asthma with lower PAL, obese and experienced psychosocial symptoms; (4) very uncontrolled asthma, physically inactive, sedentary and experienced psychosocial symptoms. Higher levels in sedentary time, female sex and anxiety symptoms were associated with increased odds of exacerbation risk, while being more active showed a protective factor for hospitalisation. Asthma control was associated with sex, the occurrence of exacerbation, PAL and health-status. <b>Conclusion:</b> Four clusters are described based on clinical traits (physical inactivity, obesity and psychosocial symptoms) which may guide management strategies to target interventions and improve asthma clinical control.