title: Persistent severe hypereosinophilic asthma is not associated with airway remodeling.
abstract: Hypereosinophilic asthma (HEA) is considered as a specific severe asthma phenotype. Whether eosinophils have a link with airway remodeling characterized by pathological (thickening of the basement membrane), functional (persistent airflow impairment and decline in lung function) and imaging features (increase airway wall thickness at CT scan) is still debated. In a one year prospective cohort of 142 severe asthma patients (according to IMI), 14 persistent HEA patients (defined by a persistent blood eosinophilia >500/mm(3) at two consecutive visits) were identified and compared with ten patients without any blood eosinophilia during the follow-up period (NEA, blood eosinophilia always <500/mm(3)). Airflow and lung volumes were recorded. Bronchial biopsies obtained at enrollment were stained for eosinophils (EG2) and basement membrane thickness (BM) was quantified. Imaging by CT scan acquisition was standardized and bronchial abnormalities quantified. ACQ score and exacerbations were prospectively recorded. HEA was not associated with preeminent features of airway remodeling assessed by airflow impairment (Best ever FEV1 values 97% ± 20 in HEA vs. 80 ± 24% in NEA, p = 0.020), decline of FEV1 (FEV1 Decline 40 ± 235 ml/y in HEA vs. 19 ± 40 ml/y in NEA, P = 0.319), submucosal abnormalities (BM thickness 7.80 ± 2.66 μm in HEA vs. 6.84 ± 2.59 in NEA, p = 0.37) and airway wall thickening at CT-scan (0.250 ± 0.036 mm vs. 0.261 ± 0.043, p = 0.92). Eosinophils blood count was inversely correlated with semiquantitative imaging score (rho -0.373, p = 0.039). Smoking history and positive skin prick tests were independent risk factors for increased BM thickening. Outcomes were similar in both populations (Control and exacerbations). Persistent HEA is not associated with evidences of airway remodeling.
authors.affiliation: Department of Respiratory Disease, APHM, Marseille, France.
authors.forename: Khuder
authors.initials: K
authors.lastname: Alagha
authors.affiliation: Department of Respiratory Disease, CHU Montpellier, Montpellier, France.
authors.forename: Baihas
authors.initials: B
authors.lastname: Jarjour
authors.affiliation: Department of Radiology, CHU Montpellier, Montpellier, France; INSERM U1046, Université Montpellier I et II, Montpellier, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Bommart
authors.affiliation: Department of Respiratory Disease, Palamos, Spain.
authors.forename: Berta
authors.initials: B
authors.lastname: Aviles
authors.affiliation: Department of Biostatistics, CHU Montpellier, Montpellier, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Varrin
authors.affiliation: Department of Respiratory Disease, CHU Montpellier, Montpellier, France.
authors.forename: Anne Sophie
authors.initials: AS
authors.lastname: Gamez
authors.affiliation: Department of Biostatistics, CHU Montpellier, Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.affiliation: Department of Respiratory Disease, CHU Montpellier, Montpellier, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Vachier
authors.affiliation: Department of Respiratory Disease, GHSR, Saint Pierre de La Réunion, France; INSERM UMR, Université Aix Marseille, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Paganin
authors.affiliation: Department of Respiratory Disease, APHM, Marseille, France; INSERM UMR, Université Aix Marseille, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Chanez
authors.affiliation: Department of Respiratory Disease, CHU Montpellier, Montpellier, France; INSERM U1046, Université Montpellier I et II, Montpellier, France. Electronic address: a-bourdin@chu-montpellier.fr.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bourdin
mesh_terms: D000328:Adult; D000368:Aged; D056151:Airway Remodeling / Q000502:physiology*; D001249:Asthma / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004802:Eosinophilia / Q000097:blood / Q000000981:diagnostic imaging; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011657:Pulmonary Eosinophilia / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: Airway remodeling; Asthma outcomes; Asthma phenotypes; Eosinophils; Severe asthma