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See detailAsthma and COPD Are Not Risk Factors for ICU Stay and Death in Case of SARS-CoV2 Infection
CALMES, Doriane ULiege; Graff, Sophie ULiege; MAES, Nathalie ULiege et al

in Journal of Allergy and Clinical Immunology: In Practice (2021), 9(1), 160-169

BACKGROUND: Asthmatics and patients with chronic obstructive pulmonary disease (COPD) have more severe outcomes with viral infections than people without obstructive disease. OBJECTIVE: To evaluate if ... [more ▼]

BACKGROUND: Asthmatics and patients with chronic obstructive pulmonary disease (COPD) have more severe outcomes with viral infections than people without obstructive disease. OBJECTIVE: To evaluate if obstructive diseases are risk factors for intensive care unit (ICU) stay and death due to coronavirus disease 2019 (COVID19). METHODS: We collected data from the electronic medical record from 596 adult patients hospitalized in University Hospital of Liege between March 18 and April 17, 2020, for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection. We classified patients into 3 groups according to the underlying respiratory disease, present before the COVID19 pandemic. RESULTS: Among patients requiring hospitalization for COVID19, asthma and COPD accounted for 9.6% and 7.7%, respectively. The proportions of asthmatics, patients with COPD, and patients without obstructive airway disease hospitalized in the ICU were 17.5%, 19.6%, and 14%, respectively. One-third of patients with COPD died during hospitalization, whereas only 7.0% of asthmatics and 13.6% of patients without airway obstruction died due to SARS-CoV2. The multivariate analysis showed that asthma, COPD, inhaled corticosteroid treatment, and oral corticosteroid treatment were not independent risk factors for ICU admission or death. Male gender (odds ratio [OR]: 1.9; 95% confidence interval [CI]: 1.1-3.2) and obesity (OR: 8.5; 95% CI: 5.1-14.1) were predictors of ICU admission, whereas male gender (OR 1.9; 95% CI: 1.1-3.2), older age (OR: 1.9; 95% CI: 1.6-2.3), cardiopathy (OR: 1.8; 95% CI: 1.1-3.1), and immunosuppressive diseases (OR: 3.6; 95% CI: 1.5-8.4) were independent predictors of death. CONCLUSION: Asthma and COPD are not risk factors for ICU admission and death related to SARS-CoV2 infection. [less ▲]

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See detailAre Volatile Organic Compounds Able to Identify Airflow Decline in Asthma?
Graff, Sophie ULiege; Zanella, Delphine ULiege; Stefanuto, Pierre-Hugues ULiege et al

in Journal of Asthma and Allergy (2021), 14

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See detailAsthma in elderly is characterized by increased sputum neutrophils, lower airway caliber variability and air trapping.
Schleich, Florence ULiege; Graff, Sophie ULiege; GUISSARD, Françoise ULiege et al

in Respiratory Research (2021), 22(1), 15

BACKGROUND: Elderly asthmatics represent an important group that is often excluded from clinical studies. In this study we wanted to present characteristics of asthmatics older than 70 years old as ... [more ▼]

BACKGROUND: Elderly asthmatics represent an important group that is often excluded from clinical studies. In this study we wanted to present characteristics of asthmatics older than 70 years old as compared to younger patients. METHODS: We conducted a retrospective analysis on a series of 758 asthmatics subdivided in three groups: lower than 40, between 40 and 70 and older than 70. All the patients who had a successful sputum induction were included in the study. RESULTS: Older patients had a higher Body Mass Index, had less active smokers and were more often treated with Long Acting anti-Muscarinic Agents. We found a significant increase in sputum neutrophil counts with ageing. There was no significant difference in blood inflammatory cell counts whatever the age group. Forced expiratory volume in one second (FEV(1)) and FEV(1)/FVC values were significantly lower in elderly who had lower bronchial hyperresponsiveness and signs of air trapping. We found a lower occurrence of the allergic component in advanced ages. Asthmatics older than 70 years old had later onset of the disease and a significant longer disease duration. CONCLUSION: Our study highlights that asthmatics older than 70 years old have higher bronchial neutrophilic inflammation, a poorer lung function, signs of air trapping and lower airway variability. The role of immunosenescence inducing chronic low-grade inflammation in this asthma subtype remains to be elucidated. [less ▲]

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See detailChronic oral corticosteroids use and persistent eosinophilia in severe asthmatics from the Belgian severe asthma registry
Graff, Sophie ULiege; Vanwynsberghe, S.; Brusselle, G. et al

in Respiratory Research (2020), 21(1), 214

BACKGROUND: Severe asthma (SA) may require frequent courses or chronic use of oral corticosteroids (OCS), inducing many known side effects and complications. Therefore, it is important to identify risk ... [more ▼]

BACKGROUND: Severe asthma (SA) may require frequent courses or chronic use of oral corticosteroids (OCS), inducing many known side effects and complications. Therefore, it is important to identify risk factors of chronic use of OCS in SA, considering the heterogeneity of clinical and inflammatory asthma phenotypes. Another aim of the present analysis is to characterize a subpopulation of severe asthmatics, in whom blood eosinophil counts (BEC) remain elevated despite chronic OCS treatment. METHODS: In a cross-sectional analysis of 982 SA patients enrolled in the Belgian Severe Asthma Registry (BSAR) between March 2009 and February 2019, we investigated the characteristics of the OCS treated patients with special attention to their inflammatory profile. RESULTS: At enrollment, 211 (21%) SA patients were taking maintenance OCS (median dose: 8 [IQR: 5-10]) mg prednisone equivalent). BEC was high (> 400/mm3) in 44% of the OCS treated population. Multivariable logistic regression analysis showed that risk factors for chronic use of OCS in SA were late-onset asthma (i.e. age of onset > 40 yr), frequent exacerbations (i.e. ≥2 exacerbations in the previous year) and non-atopic asthma. Late-onset asthma was also a predictor for persistently high BEC in OCS treated SA patients. CONCLUSION: These data showed a significant association between a persistently high BEC and late-onset asthma in OCS treated SA patients. Whether it is poor compliance to treatment or corticosteroid insensitivity the reasons for this association warrants further investigation. [less ▲]

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See detailPredictors of a good response to inhaled corticosteroids in obesity-associated asthma
Peerboom, Simon ULiege; Graff, Sophie ULiege; SEIDEL, Laurence ULiege et al

in Biochemical Pharmacology (2020)

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See detailReal-word experience with mepolizumab: Does it deliver what it has promised?
SCHLEICH, FLorence ULiege; Graff, Sophie ULiege; Nekoee Zahraei, Halehsadat ULiege et al

in Clinical and Experimental Allergy (2020)

Background: Randomized control trials performed in selected populations of severe eosinophilic asthmatics have shown that mepolizumab, an anti-IL5 therapy, was able to reduce exacerbations and OCS ... [more ▼]

Background: Randomized control trials performed in selected populations of severe eosinophilic asthmatics have shown that mepolizumab, an anti-IL5 therapy, was able to reduce exacerbations and OCS maintenance dose and in some studies, to improve asthma control and lung function. Objective: The aim of this study was to confirm the results of the RCTs in real-life in a population of 116 severe eosinophilic asthmatics treated with mepolizumab and who were followed up at the asthma clinic every month for at least 18 months. Severe asthmatics underwent FENO, lung function, asthma control and quality of life questionnaires, sputum induction and gave a blood sample at baseline, after 6 months and then every year. Results: We found a significant reduction in exacerbations by 85% after 6 months (P <.0001), which was maintained over time. We also found a significant and maintained reduction by 50% in the dose of oral corticosteroids (P <.001). Patients improved their ACT (+5.31pts, p<0.0001) ACQ (-1.13pts, P <.0001) and their AQLQ score (+1.24, P <.0001) at 6 months and this was maintained during follow-up. Only 37% reached asthma control (ACQ <1.5, ACT> 20). We observed a progressive increase in post-BD FEV1 that reached significance after 18 months (190ml or 11%, P <.01). Patients improving their FEV1had higher baseline sputum eosinophils than those not improving airway caliber. We found a significant reduction in sputum eosinophil counts by 60% after 6 months (P <.01) and a maintained reduction in blood eosinophil counts by 98% (P <.0001). Conclusion: In our real-life study, we confirm the results published in the RCTs showing a sharp reduction in exacerbation and oral corticosteroids dose and an improvement in asthma control and quality of life. Clinical relevance: Mepolizumab is efficient in severe eosinophilic asthma in real life. © 2020 John Wiley & Sons Ltd [less ▲]

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See detailIncrease in blood eosinophils during follow-up is associated with lung function decline in adult asthma.
Graff, Sophie ULiege; Demarche, Sophie ULiege; HENKET, Monique ULiege et al

in Respiratory Medicine (2019), 152

BACKGROUND: Asthma is associated with accelerated rate of lung function (FEV1) decline. OBJECTIVE: To determine predictive factors associated with FEV1 decline in adult asthma. METHODS: A retrospective ... [more ▼]

BACKGROUND: Asthma is associated with accelerated rate of lung function (FEV1) decline. OBJECTIVE: To determine predictive factors associated with FEV1 decline in adult asthma. METHODS: A retrospective study was conducted in 229 asthmatics recruited from the University Asthma Clinic of Liege. Subjects had at least two visits with post-bronchodilation (post-BD) FEV1 and minimum one year between them. A multivariable linear regression analysis was conducted in order to come up with factors associated with lung function decline. RESULTS: Post-BD FEV1 decline in % predicted. y(-1) was 0.2 (95%CI -2.0 to 2.8) in the overall population. Our population was made up of mild to moderate asthmatics [1] for 58%, aged 50 (41-60) years old, 62% were female and 59% were atopic. Median ICS dose was 1000mug beclomethasone equivalent (CFC)/day with 81% treated at baseline. Time between visits was 46.8+/-32.1 months. The univariate linear regression analysis revealed a negative association between % predicted FEV1 decline and baseline ACQ (p<0.0001) and blood eosinophils (% and/mm(3)) (p<0.0001 and p<0.0001). A positive association was found between % predicted FEV1 decline and baseline pre-BD FEV1 (mL) values (p=0.001), blood neutrophils (%) (p=0.02), change in blood eosinophils (%) (p<0.0001), time between visits (months) (p<0.0001). The predictive variables for accelerated decline highlighted by the multivariable analysis (r(2)=0.39) were change in blood eosinophils (%) over time (p=0.002) and time between visits (months) (p<0.0001). CONCLUSION: These findings highlight a new value for blood eosinophil counts as their increase over time predicts greater lung function decline in asthma. [less ▲]

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See detailMethodology for Sputum Induction and Laboratory Processing.
GUIOT, Julien ULiege; Demarche, Sophie ULiege; HENKET, Monique ULiege et al

in Journal of Visualized Experiments (2017), (130),

The technique of sputum induction and processing is a recognized non-invasive method allowing the collection and analysis of cells from the airways, which is interesting in various respiratory diseases ... [more ▼]

The technique of sputum induction and processing is a recognized non-invasive method allowing the collection and analysis of cells from the airways, which is interesting in various respiratory diseases like asthma, chronic obstructive pulmonary disease (COPD), chronic cough, or idiopathic pulmonary fibrosis. This technique is well tolerated, safe and non-invasive, but is currently limited to research services and specialized centers in clinical practice because it is technically demanding, time-consuming, and requires trained staff. The success rate of sputum induction and analysis is about 80%. Here, we describe the induction and laboratory processing of sputum samples. Sputum is induced by inhalation of hypertonic or isotonic saline with salbutamol. For the processing, we use the whole sputum technique. Dithiothreitol (DTT) is used to allow mucolysis of sputum samples. The primary aim of sputum processing is to obtain a differential cell count to study the cell types present in the airway lumen. Additional analyses may also be performed on sputum supernatant and sputum cells, which may allow further investigation into inflammatory processes and immune mechanisms. Examples include studying mediators in sputum supernatant and performing a large spectrum of analysis on sputum cells such as flow cytometry, genomics, or proteomics. Finally, representative results of sputum analysis in healthy controls, asthmatics, and COPD patients are presented. [less ▲]

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