title: Clinical characteristics and possible phenotypes of an adult severe asthma population.
abstract: BACKGROUND
  Currently, there are no studies of well-characterized severe asthmatics in Brazil. We aimed to study a population of severe treated asthmatics still uncontrolled to characterize them and define possible phenotypes.
  
  
  METHODS
  Descriptive cross-sectional outpatient study of severe asthmatics, evaluating functional and inflammatory markers, health-related quality of life, anxiety and depression symptoms, clinical control status, and characteristics related to atopy, age of asthma onset, induced sputum eosinophil levels, and airflow limitation. We also grouped the subgroups characteristics to identify phenotypes. The study is registered on ClinicalTrial.gov NCT 01089322.
  
  
  RESULTS
  From 128 eligible patients with severe/uncontrolled asthma, 74 fulfilled the inclusion criteria. The cohort was comprised of 85% women, frequently with a body mass index higher than 31 kg m(-2), atopy (60%), early-onset disease (50%), sputum eosinophilia (80%), comorbidities, and reduced quality of life. Nonatopics had significant higher asthma onset (19 y.a.) and twice level of induced sputum eosinophil. Late-onset patients had significantly less atopy (57%) and higher levels of induced sputum eosinophils. Non-eosinophilics had lower levels of inflammatory markers. Patients with airflow limitation had more intensive care unit admissions (56%) and 1.5 times more airway resistance. Subgroups characteristics identified a priori four well-characterized phenotypes, with 55% presenting sputum eosinophilia.
  
  
  CONCLUSIONS
  Our data emphasize the high burden of disease, the persistence of inflammation and the existence of clinical possible phenotypes population sharing common features with published cohorts. Despite the necessity of further investigation into pathogenic mechanisms, this study with clinically difficult patient group may help to improve future asthma care.
authors: Pulmonary Department, Heart Institute (InCor), School of Medicine, Sao Paulo University, Sao Paulo, Brazil. regina.carvalho@incor.usp.br
authors: Regina Maria
authors: RM
authors: de Carvalho-Pinto
authors: Alberto
authors: A
authors: Cukier
authors: Luciene
authors: L
authors: Angelini
authors: Leila
authors: L
authors: Antonangelo
authors: Thais
authors: T
authors: Mauad
authors: Marisa
authors: M
authors: Dolhnikoff
authors: Klaus F
authors: KF
authors: Rabe
authors: Rafael
authors: R
authors: Stelmach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000403:Airway Resistance / Q000276:immunology*; D001007:Anxiety / Q000453:epidemiology / Q000503:physiopathology; D001249:Asthma / Q000453:epidemiology / Q000235:genetics / Q000276:immunology* / Q000503:physiopathology; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000503:physiopathology; D004804:Eosinophils / Q000276:immunology*; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000453:epidemiology / Q000235:genetics / Q000276:immunology* / Q000503:physiopathology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D010641:Phenotype; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D017678:Sex Distribution; D013183:Sputum / Q000276:immunology*; D055815:Young Adult
chemical_list: D009569:Nitric Oxide