Impact of former smoking exposure on airway eosinophilic activation and autoimmunity in patients with severe asthma
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Impact of former smoking exposure on airway eosinophilic activation and autoimmunity in patients with severe asthma. / Klein, Ditte K; Silberbrandt, Alexander; Frøssing, Laurits; Hvidtfeldt, Morten; von Bülow, Anna; Nair, Parameswaran; Mukherjee, Manali; Porsbjerg, Celeste.
In: The European respiratory journal, Vol. 60, No. 4, 2102446, 2022.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Impact of former smoking exposure on airway eosinophilic activation and autoimmunity in patients with severe asthma
AU - Klein, Ditte K
AU - Silberbrandt, Alexander
AU - Frøssing, Laurits
AU - Hvidtfeldt, Morten
AU - von Bülow, Anna
AU - Nair, Parameswaran
AU - Mukherjee, Manali
AU - Porsbjerg, Celeste
N1 - Copyright ©The authors 2022. For reproduction rights and permissions contact permissions@ersnet.org.
PY - 2022
Y1 - 2022
N2 - INTRODUCTION: Severe eosinophilic asthma is characterised by frequent exacerbations and a relative insensitivity to steroids. Experimentally, smoking may induce eosinophilic airway inflammation, but the impact in patients with severe asthma is not clear.OBJECTIVE: To investigate the association between smoking exposure in patients with severe asthma, and eosinophilic inflammation and activation, as well as airway autoimmunity and steroid responsiveness.METHODS: Patients with severe asthma according to European Respiratory Society/American Thoracic Society criteria were assessed with sputum samples, analysed by cell differential count, and for the presence of free eosinophil granules (FEGs), autoantibodies against eosinophil peroxidase (EPX) and macrophage receptor with collagenous structure (MARCO). A subgroup of patients with eosinophilic airway inflammation was re-assessed after a 2-week course of prednisolone.RESULTS: 132 severe asthmatics were included in the study. 39 (29.5%) patients had ≥10 pack-years of smoking history: 36 (27.3%) were former smokers and three (2.3%) current smokers; and 93 (70.5%) had <10 pack-years exposure. Eosinophilic airway inflammation was more prevalent among patients with ≥10 pack-years (66.7%), compared to patients with <10 pack-years (38.7%, p=0.03), as was the level of FEGs (p=0.001) and both anti-EPX and anti-MARCO (p<0.05 and p<0.0001, respectively). Omitting current smokers did not affect these associations. Furthermore, prednisolone reduced, but did not normalise, sputum eosinophils in patients with a ≥10 pack-year smoking history.CONCLUSION: In patients with severe asthma, a former smoking history is associated with eosinophilic airway inflammation and activation and relative insensitivity to steroids, as well as airway autoimmunity.
AB - INTRODUCTION: Severe eosinophilic asthma is characterised by frequent exacerbations and a relative insensitivity to steroids. Experimentally, smoking may induce eosinophilic airway inflammation, but the impact in patients with severe asthma is not clear.OBJECTIVE: To investigate the association between smoking exposure in patients with severe asthma, and eosinophilic inflammation and activation, as well as airway autoimmunity and steroid responsiveness.METHODS: Patients with severe asthma according to European Respiratory Society/American Thoracic Society criteria were assessed with sputum samples, analysed by cell differential count, and for the presence of free eosinophil granules (FEGs), autoantibodies against eosinophil peroxidase (EPX) and macrophage receptor with collagenous structure (MARCO). A subgroup of patients with eosinophilic airway inflammation was re-assessed after a 2-week course of prednisolone.RESULTS: 132 severe asthmatics were included in the study. 39 (29.5%) patients had ≥10 pack-years of smoking history: 36 (27.3%) were former smokers and three (2.3%) current smokers; and 93 (70.5%) had <10 pack-years exposure. Eosinophilic airway inflammation was more prevalent among patients with ≥10 pack-years (66.7%), compared to patients with <10 pack-years (38.7%, p=0.03), as was the level of FEGs (p=0.001) and both anti-EPX and anti-MARCO (p<0.05 and p<0.0001, respectively). Omitting current smokers did not affect these associations. Furthermore, prednisolone reduced, but did not normalise, sputum eosinophils in patients with a ≥10 pack-year smoking history.CONCLUSION: In patients with severe asthma, a former smoking history is associated with eosinophilic airway inflammation and activation and relative insensitivity to steroids, as well as airway autoimmunity.
KW - Asthma
KW - Autoantibodies
KW - Autoimmunity
KW - Eosinophil Peroxidase
KW - Eosinophils
KW - Humans
KW - Inflammation
KW - Leukocyte Count
KW - Prednisolone
KW - Pulmonary Eosinophilia
KW - Smoking/adverse effects
KW - Sputum
U2 - 10.1183/13993003.02446-2021
DO - 10.1183/13993003.02446-2021
M3 - Journal article
C2 - 35236724
VL - 60
JO - The European respiratory journal
JF - The European respiratory journal
SN - 0903-1936
IS - 4
M1 - 2102446
ER -
ID: 325378049