Multimorbidity phenotypes and associated characteristics in severe asthma: an observational study of European severe asthma registries.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Freeman Anna, Rink Saša, Bansal Aruna T, Frankemölle Betty, Singh Mehar, Sont Jacob K, Bossios Apostolos, Ainsworth Ben, Hyland Michael, Chaudhuri Rekha, Matisa Dace, Mihaltan Florin, Spanevello Antonio, Heffler Enrico, Adcock Ian, Zappa Martina, Canonica Giorgio Walter, Brusselle Guy, Bourdin Arnaud, Maria Luigia Costanzo Giulia Anna, Horvath Ildiko, Lúðvíksdóttir Dóra, Principe Stefania, Kopač Peter, Loureiro Cláudia Chaves, Siddiqui Salman, Egesten Arne, Kalinauskaite-Zukauske Virginija, Dimic-Janjic Sanja, Roberts Graham, Hromis Sanja, Milenkovic Branislava, Varkonyi-Sepp Judit, Goksel Ozlem, Pereira Ana M, Djukanovic Ratko, Rizzi Angela, Caminati Marco, Hou Ruihua, Štajduhar Anamarija, Paróczai Dóra, Brussino Luisa, Heaney Liam, Haitchi Hans Michael, Bonini Matteo, Bieksiene Kristina, Damadoglu Ebru, Yasinska Valentyna, Gemicioglu Bilun, Grle Sanja Popović, Brinke Anneke Ten, Csoma Zsuzsanna, Kroica Iveta, Kuna Piotr, Dahlen Barbro, Porsbjerg Celeste, Hodge Hilary, Škrgat Sabina, Schleich Florence, Kurukulaaratchy Ramesh J
Аннотация
METHODS: Cross-sectional patient data were analysed from the pan-European Severe Heterogenous Asthma Research Collaboration: Patient Centred (SHARP) Central database of national severe asthma registries. Patients were grouped by four European regions (North, South, East, and West). Hierarchical clustering of comorbidities was applied to characterise the correlation structure of the ten commonest comorbidities within these geographical regions. Subsequent multimorbidity phenotypes (MMP) and their clinical features were then defined.
FINDINGS: Data were available for 2690 severe asthma patients and 23 comorbidities from 11 countries. Three comorbidity clusters were consistently seen across the four European regions: 1) osteoporosis plus steroid-induced weight gain, 2) eczema plus rhinitis, and 3) chronic sinusitis plus nasal polyps. Four further comorbidities (obesity, bronchiectasis, gastro-oesophageal reflux disease, psychological factors) showed variable clustering. Multimorbidity was ubiquitous. Patients were assigned multimorbidity phenotypes (MMP) according to comorbidity cluster alignment. MMP sn (sinonasal-associated) and MMP u (no specific cluster alignment) were commonest. MMP ster (steroid-associated multimorbidity) had highest maintenance oral steroid (m-OCS) use, and Body Mass Index, plus worst lung function, asthma control, and asthma exacerbation frequency. MMP max (maximal multimorbidity) showed high prevalence of variably assigned comorbidities, higher m-OCS and biologic treatment needs.
INTERPRETATION: Multimorbidity is common in severe asthma and can be classified into replicable novel phenotypes with characteristic clinical traits and outcomes. Recognising these phenotypes can guide better care of the 'whole patient' with severe asthma. Future clinical guidance should promote such understanding in order to support delivery of more effective personalised asthma care.
FUNDING: European Respiratory Society, pharmaceutical industry partners (Sanofi, TEVA, Novartis, GlaxoSmithKline, Chiesi).