Page 54 - ADULT-ONSET ASTHMA PREDICTORS OF CLINICAL COURSE AND SEVERITY

ADULT-ONSET ASTHMA – PREDICTORS OF CLINICAL COURSE AND SEVERITY
Figure 2. ROC curves for FeNO (a), blood eosinophils (b), total IgE (c) and a combined model of FeNO ASTHMA | G.A. WESTERHOF ET AL.
and blood eosinophils (d) in pa ents with di erent asthma phenotypes.
a) 1.0 0.8 0.6 0.4 0.2
Severe asthma
0.0 Mild–moderate asthma
1.0
0.8
0.6
0.4
0.2
b)
1.0
0.8
0.6
0.4
0.2
1.0
0.8
0.6
0.4
0.2
c) 1.0 0.8 0.6 0.4 0.2
d)
1.0
0.8
0.6
0.4
0.2
1.0
0.8
0.6
0.4
0.2
Obese patients
Severe asthma
Obese patients
1.0
0.8
0.6
0.4
0.2
1.0
0.8
0.6
0.4
0.2
1.0 0.8 0.6 0.4 0.2 0.0 Specificity
Ex- or current smoker
1.0
0.8
0.6
0.4
0.2
1.0 0.8 0.6 0.4 0.2 0.0 Specificity
Atopic patients
1.0
0.8
0.6
0.4
0.2
1.0 0.8 0.6 0.4 0.2 0.0 Specificity
Ex- or current smoker
1.0 0.8 0.6 0.4 0.2 0.0 Specificity
Atopic patients
0.0 Nonobese patients
0.0 Mild–moderate asthma
0.0 Nonobese patients
0.0 Nonatopic patients
0.0 Never-smoker
0.0 Nonatopic patients
0.0 Never-smoker
1.0 0.8 0.6 0.4 0.2 0.0 Specificity
1.0 0.8 0.6 0.4 0.2 0.0 Specificity
1.0 p=0.03 0.8
0.6
0.4
0.2
Obese patients 0.0 Nonobese patients
1.0 0.8 0.6 0.4 0.2 0.0 Specificity
1.0 0.8 0.6 0.4 0.2 0.0 Specificity
Severe asthma
1.0 0.8 0.6 0.4 0.2 0.0 Specificity
Obese patients
Severe asthma
0.0 Mild–moderate asthma
1.0 0.8 0.6 0.4 0.2 0.0 Specificity
1.0 p<0.01 0.8
0.6
0.4
0.2
Atopic patients 0.0 Nonatopic patients
1.0 0.8 0.6 0.4 0.2 0.0 Specificity
0.0 Mild–moderate asthma
0.0 Nonobese patients
1.0
0.8
0.6
0.4
0.2
1.0
0.8
0.6
0.4
0.2
1.0 0.8 0.6 0.4 0.2 0.0 Specificity
Atopic patients
1.0
0.8
0.6
0.4
0.2
1.0 0.8 0.6 0.4 0.2 0.0 Specificity
Ex- or current smoker
0.0 Never-smoker
0.0 Nonatopic patients
0.0 Never-smoker
Ex- or current smoker
1.0 0.8 0.6 0.4 0.2 0.0 Specificity
1.0 0.8 0.6 0.4 0.2 0.0 Specificity
1.0 0.8 0.6 0.4 0.2 0.0 Specificity
FIGURE 2 Receiver operating characteristic curves for a) exhaled nitric oxide fraction (FeNO); b) blood eosinophils; c) total immunoglobulin E; and d) a combined model (FeNO and blood eosinophils) in patients with different asthma phenotypes.
difference in the diagnostic accuracy of blood eosinophils or FeNO between mild-to-moderate and severe asthma patients, but previous studies have found conflicting results. One study found an AUC of blood eosinophils of 0.55 in corticosteroid-treated patients and of 0.73 in untreated patients [31], whereas these numbers were 0.75 and 0.62, respectively, in another study [10]. Three previous studies evaluated the accuracy of FeNO among severe/treated and mild/untreated asthma patients [8, 10, 32]. None of them found considerable differences in the differences in the AUCs. Remarkably, despite comparable AUCs for FeNO and blood eosinophils in our study, the upper threshold range for blood eosinophils was relatively wide due to the higher threshold in patients with severe asthma compared to the other asthma phenotypes (tables 4 and E10). Apparently, a subset of patients with severe asthma shows elevated levels of blood eosinophils without evidence of airway eosinophilia, which confirms previous findings [12]. Circulating
694 DOI: 10.1183/09031936.00012415
52
Sensitivity
Sensitivity
Sensitivity
Sensitivity
Sensitivity
Sensitivity
Sensitivity
Sensitivity
Sensitivity
Sensitivity
Sensitivity
Sensitivity
Sensitivity
Sensitivity
Sensitivity
Sensitivity