Cluster analysis of phenotypes, job exposure, and inflammatory patterns in elderly and nonelderly asthma patients

IF 6.2 2区 医学 Q1 ALLERGY Allergology International Pub Date : 2024-01-29 DOI:10.1016/j.alit.2024.01.001
Yung-Chi Chuang , Hsin-Hua Tsai , Meng-Chih Lin , Chao-Chien Wu , Yuan-Chung Lin , Tsu-Nai Wang
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Abstract

Background

Asthma has been identified as different phenotypes due to various risk factors. Age differences may have potential effects on asthma phenotypes. Our study aimed to identify potential asthma phenotypes among adults divided by age as either younger or older than 65 years. We also compared differences in blood granulocyte patterns, occupational asthmagens, and asthma control-related outcomes among patient phenotype clusters.

Methods

We recruited nonelderly (<65 years old) (n = 726) and elderly adults (≥65 years old) (n = 201) with mild-to-severe asthma. We conducted a factor analysis to select 17 variables. A two-step cluster analysis was used to classify subjects with asthma phenotypes, and a discriminant analysis was used to verify the classification of cluster results.

Results

There were three clusters with different characteristics identified in both the nonelderly and elderly asthmatic adults. In the nonelderly patient group, cluster 2 (obese, neutrophilic phenotypes) had a 1.85-fold significantly increased risk of asthma exacerbations. Cluster 3 (early-onset, atopy, and smoker with an eosinophil-predominant pattern) had a 2.37-fold risk of asthma exacerbations and higher oral corticosteroid (OCS) use than cluster 1 (late-onset and LMW exposure with paucigranulocytic blood pattern). Among elderly patients, cluster 2 had poor lung function and more ex-smokers. Cluster 3 (early-onset, long asthma duration) had the lowest paucigranulocytic blood pattern percentages in the elderly group.

Conclusions

The novelty of the clusters was found in age-dependent clusters. We identified three distinct phenotypes with heterogeneous characteristics, asthma exacerbations and medicine use in nonelderly and elderly asthmatic patients, respectively. Classification of age-stratified asthma phenotypes may lead to precise identification of patients, which provides personalized disease management.

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对老年和非老年哮喘患者的表型、工作接触和炎症模式进行聚类分析
背景由于各种风险因素,哮喘已被确定为不同的表型。年龄差异可能会对哮喘表型产生潜在影响。我们的研究旨在确定按年龄划分的65岁以下或65岁以上成年人的潜在哮喘表型。方法我们招募了患有轻度至重度哮喘的非老年人(65 岁)(726 人)和老年人(≥65 岁)(201 人)。我们进行了因子分析,选出了 17 个变量。结果在非老年和老年成人哮喘患者中发现了三个具有不同特征的群组。在非老年患者组中,第 2 组(肥胖、中性粒细胞表型)的哮喘恶化风险显著增加了 1.85 倍。与第 1 组(发病较晚、接触 LMW 且有白细胞血型)相比,第 3 组(发病较早、有过敏症、吸烟且以嗜酸性粒细胞为主)的哮喘恶化风险是第 1 组的 2.37 倍,口服皮质类固醇(OCS)的使用率也更高。在老年患者中,第 2 组的肺功能较差,且有更多的前吸烟者。在老年组中,第 3 组(发病早、哮喘持续时间长)的白细胞血型百分比最低。我们在非老年哮喘患者和老年哮喘患者中分别发现了具有异质性特征、哮喘恶化和药物使用的三种不同表型。对年龄分层的哮喘表型进行分类可准确识别患者,从而提供个性化的疾病管理。
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来源期刊
Allergology International
Allergology International ALLERGY-IMMUNOLOGY
CiteScore
12.60
自引率
5.90%
发文量
96
审稿时长
29 weeks
期刊介绍: Allergology International is the official journal of the Japanese Society of Allergology and publishes original papers dealing with the etiology, diagnosis and treatment of allergic and related diseases. Papers may include the study of methods of controlling allergic reactions, human and animal models of hypersensitivity and other aspects of basic and applied clinical allergy in its broadest sense. The Journal aims to encourage the international exchange of results and encourages authors from all countries to submit papers in the following three categories: Original Articles, Review Articles, and Letters to the Editor.
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