Prevalence of the eosinophilic phenotype among severe asthma patients in Brazil: the BRAEOS study

ABSTRACT Objective: To assess the prevalence of the eosinophilic and allergic phenotypes of severe asthma in Brazil, as well as to investigate the clinical characteristics of severe asthma patients in the country. Methods: This was a cross-sectional study of adult patients diagnosed with severe asthma and managed at specialized centers in Brazil. The study was conducted in 2019. Results: A total of 385 patients were included in the study. Of those, 154 had a blood eosinophil count > 300 cells/mm3 and 231 had a blood eosinophil count of ≤ 300 cells/mm3. The median age was 54.0 years, and most of the patients were female, with a BMI of 29.0 kg/m2 and a history of allergy (81.6%). The prevalence of patients with a blood eosinophil count > 300 cells/mm3 was 40.0% (95% CI: 35.1-44.9), and that of those with a blood eosinophil count > 300 cells/mm3 and a history of allergy was 31.9% (95% CI: 27.3-36.6). Age and BMI showed positive associations with a blood eosinophil count > 300 cells/mm3 (OR = 0.97, p < 0.0001; and OR = 0.96, p = 0.0233, respectively), whereas the time elapsed since the onset of asthma symptoms showed an increased association with a blood eosinophil count > 300 cells/mm3 (OR = 1.02, p = 0.0011). Conclusions: This study allowed us to characterize the population of severe asthma patients in Brazil, showing the prevalence of the eosinophilic phenotype (in 40% of the sample). Our results reveal the relevance of the eosinophilic phenotype of severe asthma at a national level, contributing to increased effectiveness in managing the disease and implementing public health strategies.

[1]  J. Brożek,et al.  “International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma.” Kian Fan Chung, Sally E. Wenzel, Jan L. Brozek, et al. Eur Respir J 2014; 43: 343–373. , 2022, European Respiratory Journal.

[2]  G. Koppelman,et al.  Biologic Therapies for Severe Asthma. , 2022, The New England journal of medicine.

[3]  Regina Maria de Carvalho-Pinto1,et al.  2021 Brazilian Thoracic Association recommendations for the management of severe asthma , 2021, Jornal Brasileiro de Pneumologia.

[4]  Á. Cruz,et al.  2021 Brazilian Thoracic Association recommendations for the management of severe asthma , 2021, Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia.

[5]  Eduardo Vieira Ponte1,et al.  Severe asthma in Brazil: from diagnosis to treatment , 2021, Jornal Brasileiro de Pneumologia.

[6]  M. Humbert,et al.  Mepolizumab in a population with severe eosinophilic asthma and corticosteroid dependence: results from a French early access programme , 2020, European Respiratory Journal.

[7]  Á. Cruz,et al.  2020 Brazilian Thoracic Association recommendations for the management of asthma , 2020, Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia.

[8]  C. Auffray,et al.  Asthma similarities across ProAR (Brazil) and U-BIOPRED (Europe) adult cohorts of contrasting locations, ethnicity and socioeconomic status. , 2019, Respiratory medicine.

[9]  J. Malka-Rais,et al.  Proportion of Severe Asthma Patients Eligible for Mepolizumab Therapy by Age and Age of Onset of Asthma. , 2019, The journal of allergy and clinical immunology. In practice.

[10]  D. Larenas-Linnemann,et al.  The characterization of asthma with blood eosinophilia in adults in Latin America , 2018, The Journal of asthma : official journal of the Association for the Care of Asthma.

[11]  G. Canonica,et al.  Type 2 immunity in asthma , 2018, The World Allergy Organization journal.

[12]  R. Suruki,et al.  Biologic treatment eligibility for real-world patients with severe asthma: The IDEAL study , 2018, The Journal of asthma : official journal of the Association for the Care of Asthma.

[13]  A. Bansal,et al.  Late Breaking Abstract - Comparison of clinical characteristics between severe adult asthmatics in Brazil(ProAR) and Europe(U-BIOPRED) , 2017 .

[14]  E. Bleecker,et al.  Baseline Features of the Severe Asthma Research Program (SARP III) Cohort: Differences with Age. , 2017, The journal of allergy and clinical immunology. In practice.

[15]  K. Rabe,et al.  Oral Glucocorticoid–Sparing Effect of Benralizumab in Severe Asthma , 2017, The New England journal of medicine.

[16]  E. Bleecker,et al.  Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial , 2016, The Lancet.

[17]  J. Corren,et al.  Phase 3 Study of Reslizumab in Patients With Poorly Controlled Asthma: Effects Across a Broad Range of Eosinophil Counts. , 2016, Chest.

[18]  “Management of the patient with eosinophilic asthma: a new era begins” Jantina C. de Groot, Anneke ten Brinke and Elisabeth H.D. Bel. ERJ Open Res 2015; 1: 00024-2016. , 2016, ERJ Open Research.

[19]  Rita Villas Boas,et al.  O curso de desenvolvimento de habilidades em pesquisa do ibge , 2015, Advances in Statistics Education: Developments, Experiences, and Assessments IASE Satellite.

[20]  Mike Thomas,et al.  Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study. , 2015, The Lancet. Respiratory medicine.

[21]  P. Nair,et al.  Blood or sputum eosinophils to guide asthma therapy? , 2015, The Lancet. Respiratory medicine.

[22]  K. Kostikas,et al.  Persistent airflow obstruction in patients with asthma: Characteristics of a distinct clinical phenotype. , 2015, Respiratory medicine.

[23]  H. Bisgaard,et al.  The burden of severe asthma in childhood and adolescence: results from the paediatric U-BIOPRED cohorts , 2015, European Respiratory Journal.

[24]  C. Auffray,et al.  Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort , 2015, European Respiratory Journal.

[25]  H. Ortega,et al.  Blood eosinophil counts predict treatment response in patients with severe eosinophilic asthma. , 2015, The Journal of allergy and clinical immunology.

[26]  E. Bel,et al.  Management of the patient with eosinophilic asthma: a new era begins , 2015, ERJ Open Research.

[27]  S. Fowler,et al.  High blood eosinophil counts predict sputum eosinophilia in patients with severe asthma. , 2015, The Journal of allergy and clinical immunology.

[28]  A. Lowe,et al.  Age-of-asthma onset as a determinant of different asthma phenotypes in adults: a systematic review and meta-analysis of the literature , 2015, Expert review of respiratory medicine.

[29]  O. Vandenplas,et al.  Heterogeneity of phenotypes in severe asthmatics. The Belgian Severe Asthma Registry (BSAR). , 2014, Respiratory medicine.

[30]  W. Busse,et al.  Benralizumab, an anti-interleukin 5 receptor α monoclonal antibody, versus placebo for uncontrolled eosinophilic asthma: a phase 2b randomised dose-ranging study. , 2014, The Lancet. Respiratory medicine.

[31]  E. Bleecker,et al.  International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma , 2013, European Respiratory Journal.

[32]  M. Martins,et al.  Eosinophilic Inflammation in Allergic Asthma , 2013, Front. Pharmacol..

[33]  Emilio Pizzichini,et al.  Avaliação do questionário de controle da asma validado para uso no Brasil , 2008 .

[34]  D. Postma,et al.  The ENFUMOSA cross-sectional European multicentre study of the clinical phenotype of chronic severe asthma , 2003, European Respiratory Journal.

[35]  I. Pavord,et al.  Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial , 2002, The Lancet.

[36]  J. R. Jardim,et al.  Validacao do questionario do Hospital Saint George na doenca respiratoria (SGRQ) em pacientes portadores de doenca pulmonar obstrutiva cronica no Brasil , 2000 .

[37]  S. Wenzel,et al.  Evidence that severe asthma can be divided pathologically into two inflammatory subtypes with distinct physiologic and clinical characteristics. , 1999, American journal of respiratory and critical care medicine.

[38]  R. Pauwels,et al.  GLOBAL STRATEGY FOR ASTHMA MANAGEMENT AND PREVENTION , 1996 .

[39]  M. Schatz,et al.  Oral corticosteroid exposure and adverse effects in asthmatic patients , 2018, The Journal of allergy and clinical immunology.

[40]  H. Walford,et al.  Diagnosis and management of eosinophilic asthma: a US perspective , 2014 .

[41]  Á. Cruz,et al.  Evaluation of the asthma control questionnaire validated for use in Brazil. , 2008, Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia.

[42]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.