SAT0217 EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS: CLINICAL PREDICTORS OF LONG-TERM ASTHMA SEVERITY
Authors: Alvise Berti, Divi Cornec, Marta Casal Moura, Robert Smith, Lorenzo Dagna, Ulrich Specks, Karina Keogh
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Bronchial asthma in Eosinophilic Granulomatosis with Polyangiitis (EGPA) patients is commonly present before, at and after the diagnosis of vasculitis, often requiring high doses of oral corticosteroid (OCS) to be controlled. <h3>Objectives:</h3> We aimed to better characterize long-term asthma in EGPA and to identify predictors of long-term asthma severity. <h3>Methods:</h3> 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. The definition from American Thoracic Society Workshop was used to identify patients with severe/uncontrolled asthma. Severe rhinosinusitis was defined as rhinosinusitis that needed sinus surgery to control nasal polyps and/or reduce symptoms (≥1 surgery). <h3>Results:</h3> 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&lt;0.01), higher serum total IgE levels (p&lt;0.05), and increased use of high dose inhaled corticosteroids (ICS) (p&lt;0.05) and OCS (p&lt;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&lt;0.05). Long-term PFT did not improve during long-term follow-up regardless of ICS and OCS therapy (both FEV1/FVC and FEV1, p&gt;0.05). Using multivariate binary logistic regressions, severe rhinosinusitis, pulmonary infiltrates, overweight and severe/uncontrolled asthma at vasculitis diagnosis independently predicted severe/uncontrolled asthma at the 3-year endpoint (Table below). <h3>Conclusion:</h3> In this large cohort of patients with EGPA, long-term severe/uncontrolled asthma is frequent, 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. <h3>References</h3> [1] Cottin V, et al. Respiratory manifestations of eosinophilic granulomatosis with polyangiitis (Churg-Strauss). The European respiratory journal. 2016;48(5):1429-41. [2] Berti A, et al. Severe/uncontrolled asthma and overall survival in atopic patients with eosinophilic granulomatosis with polyangiitis. Respiratory medicine. 2018;142:66-72. <h3>Disclosure of Interests:</h3> Alvise Berti: None declared, Divi Cornec: None declared, Marta Casal Moura: None declared, Robert Smith: None declared, Lorenzo Dagna Consultant for: Prof Lorenzo Dagna received consultation honoraria from Abbvie, Amgen, Biogen, Bristol-Myers Squibb, Celltrion, Novartis, Pfizer, Sanofi-Genzyme, and SOBI., Ulrich Specks: None declared, Karina Keogh: None declared