title: Prognostic value of cluster analysis of severe asthma phenotypes.
abstract: BACKGROUND
  Cross-sectional severe asthma cluster analysis identified different phenotypes. We tested the hypothesis that these clusters will follow different courses.
  
  
  OBJECTIVE
  We aimed to identify which asthma outcomes are specific and coherently associated with these different phenotypes in a prospective longitudinal cohort.
  
  
  METHODS
  In a longitudinal cohort of 112 patients with severe asthma, the 5 Severe Asthma Research Program (SARP) clusters were identified by means of algorithm application. Because patients of the present cohort all had severe asthma compared with the SARP cohort, homemade clusters were identified and also tested. At the subsequent visit, we investigated several outcomes related to asthma control at 1 year (6-item Asthma Control Questionnaire [ACQ-6], lung function, and medication requirement) and then recorded the 3-year exacerbations rate and time to first exacerbation.
  
  
  RESULTS
  The SARP algorithm discriminated the 5 clusters at entry for age, asthma duration, lung function, blood eosinophil measurement, ACQ-6 scores, and diabetes comorbidity. Four homemade clusters were mostly segregated by best ever achieved FEV1 values and discriminated the groups by a few clinical characteristics. Nonetheless, all these clusters shared similar asthma outcomes related to asthma control as follows. The ACQ-6 score did not change in any cluster. Exacerbation rate and time to first exacerbation were similar, as were treatment requirements.
  
  
  CONCLUSIONS
  Severe asthma phenotypes identified by using a previously reported cluster analysis or newly homemade clusters do not behave differently concerning asthma control-related outcomes, which are used to assess the response to innovative therapies. This study demonstrates a potential limitation of the cluster analysis approach in the field of severe asthma.
authors.affiliation: Department of Respiratory Diseases, Montpellier, France; INSERM U1046, Hôpital Arnaud de Villeneuve, Université Montpellier I et 2, Montpellier, France. Electronic address: a-bourdin@chu-montpellier.fr.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bourdin
authors.affiliation: INSERM U1046, Hôpital Arnaud de Villeneuve, Université Montpellier I et 2, Montpellier, France; Service DIM, MISTEA, CHU Montpellier, Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.affiliation: Department of Respiratory Diseases, Montpellier, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Vachier
authors.affiliation: Service DIM, MISTEA, CHU Montpellier, Montpellier, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Varrin
authors.affiliation: Department of Respiratory Diseases, Montpellier, France; Service DIM, MISTEA, CHU Montpellier, Montpellier, France.
authors.forename: Grégory
authors.initials: G
authors.lastname: Marin
authors.affiliation: Department of Respiratory Diseases, Montpellier, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Gamez
authors.affiliation: Department of Respiratory Diseases, Groupe Hospitalier Sud Reunion, Saint Pierre de La Réunion, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Paganin
authors.affiliation: Département des Maladies Respiratoires, AP-HM, UMR7733, Aix-Marseille Université, Marseille, France; Laboratoire INSERM CNRS U 1067, UMR7733, Aix-Marseille Université, Marseille, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Chanez
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D001249:Asthma / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011379:Prognosis; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: Clusters; exacerbation; outcomes; prospective study