Phenotypes of Inflammatory Airways Disease: Multidimensional models for classification and prediction

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Disentangling the heterogeneity of allergic respiratory diseases by latent class analysis reveals novel phenotypes

Publication . Amaral, Rita; Bousquet, Jean; Pereira, Ana M.; Araújo, Luís M.; Sá‐Sousa, Ana; Jacinto, Tiago; Almeida, Rute; Delgado, Luís; Fonseca, João A.

Background Refined phenotyping of allergic diseases may unravel novel phenotypes. Conjunctivitis as an independent disorder has never been approached. Aim To identify distinct classes of allergic respiratory diseases using latent class analysis (LCA) and distinguish each class using classification and regression tree (CART) analysis. Methods Seven hundred and twenty‐eight adults from the Portuguese general population study ICAR had a structured medical interview combined with blood collection, skin prick tests, spirometry with bronchodilation, and exhaled nitric oxide. LCA was applied to 19 variables. The CART algorithm selected the most likely variables distinguishing LCA‐classes. Results A six‐class model was obtained. Class 1 (25%): nonallergic participants without bronchial or ocular symptoms. Classes 2 (22%) and 3 (11%): nasal and ocular (low levels) symptoms without nasal impairment, monosensitized (Class 2) or polysensitized (Class 3). Class 4 (13%): polysensitized participants with high levels of nasal and ocular symptoms, and nasal impairment. Classes 5 (16%) and 6 (14%): high level of nasal, bronchial and ocular symptoms with nasal impairment (non‐allergic or polysensitized, respectively). Participants in classes 5 and 6 had more bronchial exacerbations and unscheduled medical visits (P < 0.001). Ocular symptoms were significantly higher in classes with nasal impairment, compared to those without impairment (P < 0.001) or no nasal symptom (P < 0.001). CART highlighted ocular symptoms as the most relevant variable in distinguishing LCA‐classes. Conclusion Novel severe phenotypes of participants with co‐occurrence of ocular, nasal and bronchial symptoms, and exacerbation‐prone were identified. The tree algorithm showed the importance of the ocular symptoms in the expression of allergic diseases phenotypes.

2018Journal article

Open access

Quality assessment and feedback of Smart Device Microphone Spirometry executed by children

Publication . Almeida, Rute; Pinho, Bernardo; Jácome, Cristina; Teixeira, Joao Fonseca; Amaral, Rita; Lopes, Filipa; Jacinto, Tiago; Guedes, Rui; Pereira, Mariana; Goncalves, Ivania; Fonseca, Joao Almeida

Smart device microphone spirometry, based on the audio recording of forced expiratory maneuver (FEM), can be a simple, ubiquitous and easy tool for patients to self-monitor their asthma. Automatic validity assessment is crucial to guarantee that the global effort of the FEM fulfil the admissible minimum or if the maneuver needs to be repeated. In this work an automatic method to classify the sounds from FEM with respect to global effort was developed and evaluated using data from 54 children (5-10 years). The method proposed was able to correctly classify the microphone spirometry with respect to admissible minimum of effort with an accuracy of 86% (specificity 87% and sensitivity 86%). This method can be used to provide immediate feedback of the correct execution of the maneuver, improving the clinical value and utility of this self-monitoring tool.

2019Conference object

Restricted access

Having concomitant asthma phenotypes is common and independently relates to poor lung function in NHANES 2007-2012

Publication . Amaral, Rita; Fonseca, João A; Jacinto, Tiago; Pereira, Ana M; Malinovschi, Andrei; Janson, Christer; Alving, Kjell

Evidence for distinct asthma phenotypes and their overlap is becoming increasingly relevant to identify personalized and targeted therapeutic strategies. In this study, we aimed to describe the overlap of five commonly reported asthma phenotypes in US adults with current asthma and assess its association with asthma outcomes. Data from the National Health and Nutrition Examination Surveys (NHANES) 2007–2012 were used (n = 30,442). Adults with current asthma were selected. Asthma phenotypes were: B-Eos-high [if blood eosinophils (B-Eos) ≥ 300/mm3]; FeNO-high (FeNO ≥ 35 ppb); B-Eos&FeNO-low (B-Eos < 150/mm3 and FeNO < 20 ppb); asthma with obesity (AwObesity) (BMI ≥ 30 kg/m2); and asthma with concurrent COPD. Data were weighted for the US population and analyses were stratified by age (< 40 and ≥ 40 years old). Of the 18,619 adults included, 1059 (5.6% [95% CI 5.1–5.9]) had current asthma. A substantial overlap was observed both in subjects aged < 40 years (44%) and ≥ 40 years (54%). The more prevalent specific overlaps in both age groups were AwObesity associated with either B-Eos-high (15 and 12%, respectively) or B-Eos&FeNO-low asthma (13 and 11%, respectively). About 14% of the current asthma patients were “non-classified”. Regardless of phenotype classification, having concomitant phenotypes was significantly associated with (adjusted OR, 95% CI) ≥ 2 controller medications (2.03, 1.16–3.57), and FEV1 < LLN (3.21, 1.74–5.94), adjusted for confounding variables. A prevalent overlap of commonly reported asthma phenotypes was observed among asthma patients from the general population, with implications for objective asthma outcomes. A broader approach may be required to better characterize asthma patients and prevent poor asthma outcomes.

2018Journal article

Open access

Having concomitant asthma phenotypes is common and independently relates to poor lung function in NHANES 2007–2012

Publication . Amaral, Rita; Fonseca, João A.; Jacinto, Tiago; Pereira, Ana M.; Malinovschi, Andrei; Janson, Christer; Alving, Kjell

Evidence for distinct asthma phenotypes and their overlap is becoming increasingly relevant to identify personalized and targeted therapeutic strategies. In this study, we aimed to describe the overlap of five commonly reported asthma phenotypes in US adults with current asthma and assess its association with asthma outcomes. Data from the National Health and Nutrition Examination Surveys (NHANES) 2007–2012 were used (n = 30,442). Adults with current asthma were selected. Asthma phenotypes were: B-Eos-high [if blood eosinophils (B-Eos) ≥ 300/mm3]; FeNO-high (FeNO ≥ 35 ppb); B-Eos&FeNO-low (B-Eos < 150/mm3 and FeNO < 20 ppb); asthma with obesity (AwObesity) (BMI ≥ 30 kg/m2); and asthma with concurrent COPD. Data were weighted for the US population and analyses were stratified by age (< 40 and ≥ 40 years old). Of the 18,619 adults included, 1059 (5.6% [95% CI 5.1–5.9]) had current asthma. A substantial overlap was observed both in subjects aged < 40 years (44%) and ≥ 40 years (54%). The more prevalent specific overlaps in both age groups were AwObesity associated with either B-Eos-high (15 and 12%, respectively) or B-Eos&FeNO-low asthma (13 and 11%, respectively). About 14% of the current asthma patients were “non-classified”. Regardless of phenotype classification, having concomitant phenotypes was significantly associated with (adjusted OR, 95% CI) ≥ 2 controller medications (2.03, 1.16–3.57), and FEV1 < LLN (3.21, 1.74–5.94), adjusted for confounding variables. A prevalent overlap of commonly reported asthma phenotypes was observed among asthma patients from the general population, with implications for objective asthma outcomes. A broader approach may be required to better characterize asthma patients and prevent poor asthma outcomes.

2018Journal article

Open access