Obesity and aspirin intolerance are risk factors for difficult-to-treat asthma in Japanese non-atopic women
Article first published online: 10 OCT 2011
© 2011 Blackwell Publishing Ltd
Clinical & Experimental Allergy
Special Issue: Special Issue on Severe Asthma
Volume 42, Issue 5, pages 738–746, May 2012
How to Cite
Cite this as: Y. Fukutomi, M. Taniguchi, T. Tsuburai, H. Tanimoto, C. Oshikata, E. Ono, K. Sekiya, N. Higashi, A. Mori, M. Hasegawa, H. Nakamura and K. Akiyama, Clinical & Experimental Allergy, 2012 (42) 738–746.
- Issue published online: 20 APR 2012
- Article first published online: 10 OCT 2011
- Manuscript Accepted: 25 AUG 2011
- Manuscript Revised: 23 AUG 2011
- Manuscript Received: 13 DEC 2010
- aspirin intolerance;
- asthma phenotype;
- difficult-to-treat asthma;
- gender difference;
Asthma is a clinical syndrome characterized by variabilities in disease expression and severity. The pathophysiological mechanism underlying anti-asthma treatment resistance is also assumed to be different between disease phenotypes.
To elucidate the effect of gender and atopic phenotype on the relationship between clinical factors and the risk of treatment resistance.
We compared outpatients with difficult-to-treat asthma (DTA; n = 486) in a tertiary hospital for allergic diseases in central Japan with those with controlled severe asthma (n = 621) with respect to clinical factors including body mass index (BMI) and aspirin intolerance using multivariate logistic regression analysis stratified by gender and atopic phenotype.
When analysis was performed on the entire study populations, obesity (BMI ≥ 30 kg/m2; adjusted odds ratio (OR) 1.92; 95% confidence interval (95% CI: 1.07–3.43) and aspirin intolerance (OR: 2.56, 95% CI: 1.44–4.57) were found to be the significant risk factors for DTA. However, after the stratification by gender and atopic phenotype, the association between obesity and DTA was significant only in women (OR: 2.76, 95% CI: 1.31–5.78), but not in men (OR: 1.03, 95% CI: 0.38–2.81), and only in non-atopics (OR: 4.03, 95% CI: 1.15–14.08), but not in atopics (OR: 1.54, 95% CI: 0.79–3.02). The similar gender and phenotypic differences were also observed in the association between aspirin intolerance and DTA: namely, the association was significant only in women (OR: 3.96, 95% CI: 1.84–8.50), but not in men (OR: 1.19, 95% CI: 0.46–3.05); and only in non-atopics (OR: 5.49, 95% CI: 1.98–15.19), but not in atopics (OR: 1.39, 95% CI: 0.65–2.98).
Conclusions and Clinical Relevance
Significant associations of obesity and aspirin intolerance with DTA were observed only in women and in non-atopics. These findings suggest that a phenotype-specific approach is needed to treat patients with DTA.