Asthma phenotypes in our region and their properties

BACKGROUND Phenotype of an organism is a feature which results in with interaction of genetical infrastructure and environmental factors. Asthma is an inflammatory disease of airways and constantly existing inflammation may lead asthmatic attacks with the effect of environmental agents. It is important to know these factors for the management of disease. In this subject, there is no available national data in Turkey. In this study, our aim was to have detailed information by triggering factors for asthmatic patients in our region, defining the phenotypes of asthma and comparison of these two data groups. Besides, in this study, we investigated control of disease and taking medicine. MATERIALS AND METHODS 169 In/Out patients were admitted in this study with these criteria: Patients mustn't be under 18 years old. At least one month should pass after the asthma attack. On cluster analyses, phenotypes of asthma were classified as atopic asthma, non-atopic asthma, eosinophilic asthma, aspirin triggered asthma, menstruale asthma, occupational asthma, obese asthma, late-onset asthma and early onset asthma. In our study, the cases were groupped as atopic asthma, non-atopic asthma, cigarette smoker asthmatic patients, non-smoker asthmatic patients, patients who have normal weight and who are slim, patients who are overweight and obese. Besides, previous medications, method of using the medication, asthma control test, comorbidities and triggering factors were investigated. RESULTS 127 of 169 patients were females, 42 of 169 were males. The mean age was 39,82. The most common age of onset was between 18-39 years (%55). 102 patients (%60,4) were never smoked before and 67 patients were smoker or ex-smoker (%39,6). 115 (%68,1) patients' body-mass index were ≥25 and 54 patients' body-mass index were <25. 28 (16,8%) patients had atopic asthma and 139 patients (%83,2) had non-atopic asthma. 68 patients (40,23%) were misusing the medication and using method of medication of 101 patients (59,77%) was correct. ACT (asthma control test) (p<0.001), FEV1 ratio (p=0.05), and PEF ratio (p=0.04) were found significantly higher in the group of patient who uses the medication correctly. Age (p<0.001), initiation age of asthma (p=0.001) were significantly found lower in the patients with BMI<25. Diabetes Mellitus and Hypertension were significantly found higher in the patients with BMI≥ 25. The mean age and the initiation age of asthma were significanlty lower in the patients with positive atopia. Besides, a stastistically significant relation was found between positive reversibility (p=0.05), higher values of total IgE (p=0.023), and history of taking the psychological medication ( p=0.008) in the patients with atopia. No significant relation could found between smoking and PFT values and ACT scores. We concluded that having many ex-smoker and little burden of tobacco in our study. There was a positive correlation between FEV1 ratio and ACT scores ( p≤0.05), there was a negative correlation between history of admission to hospital for lifelong time and history of admission to hospital in last one year (p≤0.005). A negative correlation between severeness of asthma and ACT scores (p≤0.05) and a positive correlation between severeness and admission in lifetime (p≤0.05) were found. There was a negative correlation between admissions in lifetime and in last one year to the emergency clinic, and hospitalization in patients with lower ACT scores. DISCUSSION Patients who took the medication irregularly and misuse had lover PFT parameters and their asthmas were not under control, as a result of that, these patients had more admissions to the emergency clinic and these patients were hospitalized more often in their lifetime. Therefore, we decided that to organize educational meetings with patients about their diseases due to our patients' lower cultural level. Majority of patients who have obese phenotype were women, mean age was high and comorbidities had increased. There is a increasing risk pattern of asthma with age by obesity. Therefore, prevalance of asthma might be decreased by eradication of this risk factor. On diagnosis and treatment, there should be an awareness about increasing risk of asthma and comorbidities which increases along with obesity by being older. In the obese asthma patients, rate of female gender was found higher. We think that women have more risks about asthma developed by age-related obesity. It was observed that the atopic phenotyped patients were younger and had more psychiatric disorders. For detection of atopia in this phenotype, total IgE levels, positiveness of reversibility and peripheric eosinophilia may be used as criteria. Most often detected allergen agent was polens in our region. Besides, history of uptake of psychiatric medications should be investigated in atopic patients.