Browse ATS 2021 Abstracts

HomeProgram ▶ Browse ATS 2021 Abstracts

ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.

Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.

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Does Baseline Peripheral Eosinophilia Predict Biological Therapy Treatment Failure in Poorly Controlled Asthmatics

Session Title
A1461 - Does Baseline Peripheral Eosinophilia Predict Biological Therapy Treatment Failure in Poorly Controlled Asthmatics
Author Block: Z. L. Dorey-Stein1, I. Yousef1, S. Titterfante2, H. Zhao3, T. Buckey2, W. Satz4, A. B. Karanam2, K. V. Shenoy1; 1Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, United States, 2Internal Medicine, Temple University, Philadelphia, PA, United States, 3Department of Clinical Sciences, Temple University, Philadelphia, PA, United States, 4Emergency Medicine, Temple University, Philadelphia, PA, United States.
Rationale: Asthma is a heterogeneous disease of chronic intermittent inflammation of the airways. Uncontrolled severe asthma is associated with increased mortality, morbidity, poorer quality of life and increased health expenditures. The development of monoclonal antibody therapy targeting specific chemokines has improved previously uncontrolled patients’ lives, however despite these advances, there remains a subset of asthma patient on monoclonal antibody therapy who remain symptomatic with disproportionate utilization of the healthcare system. We hypothesized that elevated baseline peripheral eosinophilia would be predictive of increase monoclonal antibody treatment failure. Methods: We conducted a single center retrospective chart review of patients with uncontrolled severe persistent asthma initiated on any form of monoclonal antibody therapy from January 1, 2015 to June 1, 2019. Inclusion criteria included uncontrolled asthma on monoclonal antibody therapy, CBC with differential completed within one year of treatment initiation off corticosteroids for at least 4 weeks, and a minimum of 4 outpatient follow up visits with pulmonologist after starting biological therapy. Treatment failure was defined as discontinuation or changing monoclonal antibody due to persistent exacerbations or an inability to decrease chronic oral corticosteroid dose. Results: 62 patients were identified that met the above inclusion criteria. 46% of the patients were identified in the treatment failure cohort and 54% were well controlled on monoclonal antibody therapy and served as a control cohort. The treatment failure cohort was 68.9% male, 54.9 years of age, and a baseline mean peripheral eosinophilia of 454 cells per microliter. The control group was 54.5% male, 60.5 years of age, and a baseline mean peripheral eosinophilia of 482 cells per microliter. Comorbidities associated with asthma and frequency of exacerbations were similar between the two groups with the exception of obstructive sleep apnea, which was present in 37.93% of the treatment failure cohort versus 15.15% of the control group (P= .048). Conclusion: Baseline peripheral eosinophilia is not predictive of monoclonal antibody treatment failure in uncontrolled asthmatic. Limitations of our study include excluding individuals with severe uncontrolled asthma due to no CBC completed off of systemic glucocorticoids as this may have formed a selection bias and eliminated individuals with the greatest Th2 inflammation from our analysis. The statistically significant finding of increase OSA incidence in the treatment failure group speaks to the well described systemic inflammation associated with both pathologies, and the importance of identifying new targets for monoclonal antibody treatment.