The Phenotypes of Asthma-Bronchiectasis Overlap: Clinical Characteristics and Outcomes.

IF 4.3 2区医学 Q2 ALLERGY

Allergy, Asthma & Immunology Research Pub Date : 2025-03-01 DOI:10.4168/aair.2025.17.2.196

Zhen-Hong Lin, Cui-Xia Pan, Jia-Hui He, Xiao-Xian Zhang, Sheng-Zhu Lin, Qing-Ling Zhang, Mei Dai, Wei-Quan Liang, Wei-Jie Guan

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Abstract

Background: Asthma-bronchiectasis overlap (ABO) encompasses heterogeneous manifestations, which may predict distinct clinical outcomes. We sought to identify the clinical phenotypes of ABO and compare them to asthma alone or bronchiectasis alone.

Methods: In this retrospective cohort study, we extracted electronic medical records from 292 inpatients with ABO, 901 inpatients with asthma alone, and 1,192 inpatients with bronchiectasis alone who were hospitalized between 2015 and 2020. We phenotyped ABO using 2-step unsupervised clustering analysis by using an independent cohort (n = 76).

Results: Compared to asthma or bronchiectasis alone, ABO exhibited greater disease severity and worse clinical outcomes. We identified 3 ABO phenotypes: asthma-dominant ABO (ABO-A, n = 100) with more prominent asthma symptoms; bronchiectasis-dominant ABO (ABO-B, n = 89) with more pronounced features of bronchiectasis; and co-existence of asthma and severe bronchiectasis (ABO-S, n = 103) with worse clinical outcomes. Compared to ABO-B, both ABO-A and ABO-S were associated with significantly higher blood neutrophil ratios (55.8% vs. 59.1% vs. 64.4%, P < 0.001), poorer lung function (FEV1% predicted: 79.1% vs. 67.5% vs. 50.1%, P < 0.001), longer hospital stay (6.0 vs. 7.0 vs. 7.0 days, P = 0.004), and higher risks of hospitalization within the next 2 years (ABO-A: hazards ratio [HR], 3.76, 95% confidence interval [CI], 1.12-12.62, P = 0.032; ABO-S: HR, 4.05, 95% CI, 1.14-14.36, P = 0.031).

Conclusions: The radiologic severity of bronchiectasis and the use of systemic corticosteroids can identify the clinical phenotypes of ABO. The heterogeneity of clinical manifestations may help formulate personalized management strategies and predict the prognosis of ABO.

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哮喘-支气管扩张重叠的表型：临床特征和结果。

背景：哮喘-支气管扩张重叠（ABO）包括不同的表现，可以预测不同的临床结果。我们试图确定ABO的临床表型，并将其与哮喘单独或支气管扩张单独进行比较。方法：在回顾性队列研究中，我们提取了2015 - 2020年住院的292例ABO住院患者、901例单独哮喘住院患者和1192例单独支气管扩张住院患者的电子病历。我们使用独立队列（n = 76），采用两步无监督聚类分析对ABO进行表型分析。结果：与哮喘或支气管扩张相比，ABO表现出更大的疾病严重程度和更差的临床结果。我们确定了3种ABO表型：哮喘显性ABO (ABO- a, n = 100)，哮喘症状更突出；支气管扩张-显性ABO (ABO- b, n = 89)，支气管扩张特征更为明显；哮喘和严重支气管扩张共存（ABO-S, n = 103），临床预后较差。与ABO-B相比，ABO-A和ABO-S与血液中性粒细胞比例显著升高（55.8%比59.1%比64.4%,P < 0.001）、肺功能较差（FEV1%预测：79.1%比67.5%比50.1%,P < 0.001）、住院时间较长（6.0比7.0比7.0天，P = 0.004）、未来2年内住院风险较高(ABO-A：风险比[HR]， 3.76, 95%可信区间[CI]， 1.12-12.62, P = 0.032；Abo-s: hr, 4.05, 95% ci, 1.14-14.36, p = 0.031)。结论：支气管扩张的放射学严重程度和全身皮质类固醇的使用可以识别ABO的临床表型。临床表现的异质性有助于制定个性化的治疗策略和预测ABO预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Allergy, Asthma & Immunology Research ALLERGY-IMMUNOLOGY

CiteScore

6.10

自引率

6.80%

发文量

审稿时长

>12 weeks

期刊介绍： The journal features cutting-edge original research, brief communications, and state-of-the-art reviews in the specialties of allergy, asthma, and immunology, including clinical and experimental studies and instructive case reports. Contemporary reviews summarize information on topics for researchers and physicians in the fields of allergy and immunology. As of January 2017, AAIR do not accept case reports. However, if it is a clinically important case, authors can submit it in the form of letter to the Editor. Editorials and letters to the Editor explore controversial issues and encourage further discussion among physicians dealing with allergy, immunology, pediatric respirology, and related medical fields. AAIR also features topics in practice and management and recent advances in equipment and techniques for clinicians concerned with clinical manifestations of allergies and pediatric respiratory diseases.