030. Clinical phenotypes in asthmatic population with severe asthma

Objective: Assessment of clinical characteristics of severe asthma.

Methods: Retrospective study of the medical records of 3850 patients followed in our Asthma Clinic during the previous five years.

Results: 78 patients, 56 women and 26 men, mean age was 53.51±14.24 years (range, 20-81 years), suffering from severe asthma according to the 2014 ERS/ATS criteria, were found. Average body mass index (BMI) was 30.31±6.47, with 33% of subjects exhibiting BMI >30. Regarding pulmonary function testing (PFT), mean FEV₁ was 81.10%±21.38% predicted, FVC: 89.78%±19.09%, FEV₁/FVC: 75.19%±11.63, RV: 96.85%±31.98% and TLC: 89.51%±13.59%. 33 patients exacerbated during the previous year, while 12 of them required hospitalization. Average onset of asthma was 38 years and the mean duration of symptoms was 14.97±11.06 years. 17 patients reported a family history of asthma, 12 were current and 14 ex-smokers. Rhinitis was found in 34, nasal polyps in 12, aspirin intolerance in seven and clinical Gastroesophageal reflux disease (GERD) in three patients. Atopy was documented in 39%, with 25 patients demonstrating positive skin tests to pollens (Olive: nine, Grasses: seven, Chenopodium: three, Parietaria: three, various other pollens: three), 17 to mites, two to Alternaria, two to dog dander and 12 to other allergens. Occupational asthma was recorded in two and bronchospasm during exercise in six patients. 31 patients underwent High-resolution computed tomography (HRCT) imaging; major findings were centrilobular nodules, mosaic pattern, ground glass opacities, bronchial thickening, bronchiectasis and emphysema. All patients were receiving high doses of inhaled corticosteroids, 79% >1200 mcg of budesonide equivalent (1,600±600 mcg), while eirht patients were on permanent treatment with oral corticosteroids, at an average dose of 8.64±2.38 mg. Furthermore, all patients were receiving LABAs, 22 tiotropium, 19 montelukast and, finally, 17 patients omalizumab. Eventually, asthma control was not achieved in 30% of patients (ACT ≤19).

Conclusions: The incidence of severe asthma in our cohort was estimated approximately in 2%. Late-onset, non-allergic, obese and female predominant were the most common clinical phenotypes.

Keywords: Asthma; bronchodilators; spirometry