Work

129. Respiratory Involvement in Patients With Eosinophilic Granulomatosis With Polyangiitis: Clinical and Serological Predictors of Long-term Asthma Severity

Year: 2019

Type: article

Abstract: Background: Asthma in Eosinophilic Granulomatosis with Polyangiitis (EGPA) patients is commonly present before, at and after the diagnosis of vasculitis. We aimed to better characterize long-term asthma in EGPA and to identify predictors of long-term asthma severity. Methods: Retrospective cohort study of anti-neutrophil cytoplasmic antibodies associated vasculitis patients who fulfilled standardized criteria for EGPA (American College of Rheumatology 1990 and/or Lanham criteria and/or Chapel Hill Consensus Conference 2012) that were followed in a single referral center from 1990-2017. Baseline and 3 (+/-1) years of follow-up clinical, laboratory and pulmonary function data were analyzed. Results: One-hundred-eighty-seven patients with EGPA were identified, from which 89 patients with documented asthma assessment at baseline and after 3 years from diagnosis were included. Severe/uncontrolled asthma was observed in 42.7% of patients at diagnosis and was associated with a previous history of respiratory allergy (p < 0.01), higher serum total IgE levels (p < 0.05), and increased use of high dose inhaled corticosteroids (ICS) (p < 0.05) and oral CS (OCS) (p < 0.001) for respiratory symptoms the year before the diagnosis of EGPA. Improvement or worsening of asthma during follow-up was experienced by 22.4% patients, with no discriminative baseline features that allowed their distinction. Severe/uncontrolled asthma was present in 40.5% of patients at 3 years, and was associated with increased airway resistance on pulmonary function testing (p < 0.05). Long-term PFT did not improve during long-term follow-up regardless of ICS and OCS therapy (Figure). Using multivariate binary logistic regressions, severe rhinosinusitis (p = 0.038), pulmonary infiltrates (p = 0.011), overweight (BMI>25kg/m2; p = 0.041) and severe/uncontrolled asthma at vasculitis diagnosis (p < 0.001) independently predicted severe/uncontrolled asthma at the 3 year endpoint. Conclusion: In this large cohort of patients with EGPA, long-term severe/uncontrolled asthma is usually severe, and patients affected display a higher proportion of bronchial obstruction and have more severe airway resistance. Overall, pulmonary function does not improve during the follow-up regardless of ICS and OCS therapy. Finally, long-term severe/uncontrolled asthma is associated with baseline pulmonary and ENT manifestations, but not with vasculitic features. Disclosures: None

Source: Rheumatology

DOI: 10.1093/rheumatology/kez059.006