Lung Function Trajectory Types in Never-Smoking Adults With Asthma: Clinical Features and Inflammatory Patterns
- Authors
- Kim, Joo-Hee; Chang, Hun Soo; Shin, Seung Woo; Baek, Dong Gyu; Son, Ji-Hye; Park, Choon-Sik; Park, Jong-Sook
- Issue Date
- Sep-2018
- Publisher
- 대한천식알레르기학회
- Keywords
- Adult; asthma; disease progression; forced expiratory volume; inflammation; phenotype
- Citation
- Allergy, Asthma & Immunology Research, v.10, no.5-6, pp 614 - 627
- Pages
- 14
- Journal Title
- Allergy, Asthma & Immunology Research
- Volume
- 10
- Number
- 5-6
- Start Page
- 614
- End Page
- 627
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/5658
- DOI
- 10.4168/aair.2018.10.6.614
- ISSN
- 2092-7355
2092-7363
- Abstract
- Purpose: Asthma is a heterogeneous disease that responds to medications to varying degrees. Cluster analyses have identified several phenotypes and variables related to fixed airway obstruction; however, few longitudinal studies of lung function have been performed on adult asthmatics. We investigated clinical, demographic, and inflammatory factors related to persistent airflow limitation based on lung function trajectories over 1 year. Methods: Serial post-bronchodilator forced expiratory volume (FEV) 1% values were obtained from 1,679 asthmatics who were followed up every 3 months for 1 year. First, a hierarchical cluster analysis was performed using Ward's method to generate a dendrogram for the optimum number of clusters using the complete post-FEV1 sets from 448 subjects. Then, a trajectory cluster analysis of serial post-FEV1 sets was performed using the k-means clustering for the longitudinal data trajectory method. Next, trajectory clustering for the serial post-FEV1 sets of a total of 1,679 asthmatics was performed after imputation of missing post-FEV1 values using regression methods. Results: Trajectories 1 and 2 were associated with normal lung function during the study period, and trajectory 3 was associated with a reversal to normal of the moderately decreased baseline FEV1 within 3 months. Trajectories 4 and 5 were associated with severe asthma with a marked reduction in baseline FEV1. However, the FEV1 associated with trajectory 4 was increased at 3 months, whereas the FEV1 associated with trajectory 5 was persistently disturbed over 1 year. Compared with trajectory 4, trajectory 5 was associated with older asthmatics with less atopy, a lower immunoglobulin E (IgE) level, sputum neutrophilia and higher dosages of oral steroids. In contrast, trajectory 4 was associated with higher sputum and blood eosinophil counts and more frequent exacerbations. Conclusions: Trajectory clustering analysis of FEV1 identified 5 distinct types, representing well-preserved to severely decreased FEV1. Persistent airflow obstruction may be related to non-atopy, a low IgE level, and older age accompanied by neutrophilic inflammation and low baseline FEV1 levels.
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Collections - College of Medicine > Department of Internal Medicine > 1. Journal Articles
- College of Medicine > Soonchunhyang Institute of Medicine > 1. Journal Articles
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