Abstract

Background
biomarkers of Type 2 (T2) inflammation may predict asthma control and exacerbation risk. However, the relationships between individual T2 biomarkers to exacerbations and lung function in severe asthma remain uncertain.

Objectives
to explore the roles played by T2 biomarkers individually and as a composite score in predicting clinical outcomes in severe asthma.

Methods
unselected severe asthma patients were enrolled in this cross sectional real life study. Participants were clinically characterised and the following measurements were obtained: the frequency of exacerbations requiring oral corticosteroids (OCS), asthma control (Juniper ACQ6-7), lung function, Fraction exhaled Nitric Oxide (FeNO), peripheral blood eosinophils (PBE), and serum periostin.

Results
A total of 115 patients were recruited [mean age 45 years (range 18–70), 80 (69.6%) females, mean forced expiratory volume in first second (FEV1) %predicted was 68%?±?24.7, mean inhaled corticosteroids (ICS) 1.96?±?0.82?mg/day. FeNO correlated significantly with PBE (r?=?0.35, p?=?0.0004), but not with periostin (r?=?0.22, p?=?0.065) and there was no significant correlation between PBE and periostin. FeNO correlation with exacerbations (r?=?0.42, p?=?0.0008) was stronger than PBE and periostin. A composite score of the 3 biomarkers correlated with exacerbations in a dose-dependent manner but multiple regression analysis did not confirm an added benefit. Only periostin demonstrated a significant correlation with FEV1% predicted (r?=?-0.34, p?=?0.004) with ROC-AUC 0.7.

Conclusion
FeNO demonstrated stronger correlation with asthma exacerbations than PBE or periostin with no definite added benefit from a composite score of the 3 biomarkers. Only periostin showed significant association with reduced lung function raising its potential as a biomarker of airway remodeling.

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