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Four subclasses (subphenotypes) of AERD: All AERD patients are not the same

Certain subphenotypes of aspirin-exacerbated respiratory disease distinguished by latent class analysis.

AERD/Samter’s Triad is recognized as a distinct asthma phenotype, but the recent work of Dr. Ewa Nizankowska-Mogilnicka and the late Dr. Andrzej Szczeklik, now sheds new insights on the disease, and shows that individual patients with AERD are not homogeneous. They identified four classes or subphenotypes of AERD: Class 1, moderate asthma, intensive upper airway symptoms, and blood eosinophilia (18.9% of patients); Class 2, mild and relatively well-controlled asthma with low health care use (34.8% of patients); Class 3, severe and poorly controlled asthma with severe exacerbations and airway obstruction (41.3% of patients); and Class 4, poorly controlled asthma with frequent and severe exacerbations in female subjects (5.0% of patients). Atopic/allergic status did not affect class membership. Patients with particularly intensive upper airway symptoms had the highest levels of blood eosinophilia and the highest concentrations of urinary LTE4. Understanding what leads to such discrimination might facilitate more individualized treatment in difficult-to-treat patients. Further work is underway to learn more about whether class membership affects the severity of aspirin-induced reactions, or predicts the therapeutic response to treatment with high-dose aspirin.

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