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Identification of Asthma Phenotypes in a Tertiary Care Medical Center #MMPMID25319436
Kuhlen JL; Wahlquist AE; Nietert PJ; Bains SN
Am J Med Sci 2014[Dec]; 348 (6): 480-5 PMID25319436show ga
Background: Asthma affects 5?10% of the population and its severity is assessed using four parameters: lung function, symptom frequency, rescue inhaler use, and number of asthma exacerbations1?2. Asthma is increasingly recognized as a clinical syndrome rather than a single disease3. However, the current classification system fails to reflect the heterogeneous characteristics of the disease4. Methods: A retrospective chart review of 139 patients with mild, moderate, and severe persistent asthma was performed. Variables including baseline and maximal FEV1 (percent predicted), and age of asthma onset were used to classify patients. Results: This yielded five clusters(C) similar to SARP. Subjects in C1 (n=32) and C2 (n= 47) had early onset atopic asthma and reduced lung function but differed in medication requirement and health care utilization (HCU). C3 (n=32) consisted of older obese women with late onset asthma, less atopy, and mildly reduced FEV1. Members of C4 (n=20) and C5 (n=8) had atopic asthma with severe obstruction but differed in bronchodilator response, age of onset, and oral corticosteroid use. Compared to SARP, our subjects were older, had a higher percentage of African Americans and obesity, and less severe asthma (p <0.05).The observed clusters differed from SARP clusters in the following: 1) More frequent asthma exacerbations and medication use among C1 and 2, 2) Lower medication use in C3 and 4, 3) Although total HCU was similar, there were fewer ED visits in C3 (p<0.05). Conclusion: The SARP algorithm may be used to classify diverse asthmatic populations into a clinically reproducible phenotypic cluster.