ArticleBMC pulmonary medicine2026
Beyond symptoms: uncovering type 2 inflammation and small airway dysfunction in Treatment-Naïve asthma.
Article in BMC pulmonary medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDespite guideline-based therapy, asthma control remains suboptimal in primary care, suggesting initial assessments may overlook key treatable traits.
objectiveTo assess the prevalence of Type 2 (T2) inflammation and small airway dysfunction (SAD) in treatment-naïve uncontrolled asthma, evaluate the utility of Asthma Control Questionnaire-5 (ACQ-5) in their identification.
methodsThis retrospective, single-center study included 171 treatment-naïve adults with uncontrolled asthma (ACQ-5 score ≥ 1.5). A T2-High phenotype was defined as blood eosinophil count ≥ 300 cells/μL and fractional exhaled nitric oxide (FeNO) > 50 ppb. Spirometric categories were defined as: isolated SAD (iSAD) as forced expiratory volume in 1 second (FEV1) ≥ 80% predicted with forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75) < 65% predicted, and airflow limitation (AFL) as FEV1 < 80% predicted. Logistic regression and receiver operating characteristic (ROC) analyses were performed.
resultsA significant burden of underlying pathology was found, with 48.0% exhibiting a T2-High phenotype and 21.1% having iSAD. While higher ACQ-5 scores strongly associated with AFL (area under the curve [AUC] = 0.802), they were not associated with iSAD and showed poor utility for detecting the T2-High phenotype (AUC = 0.634).
conclusionIn treatment-naïve uncontrolled asthma, ACQ-5 scores effectively identify overt AFL but fail to detect underlying iSAD and high-intensity T2 inflammation. These findings highlight a critical discordance between patient-reported symptoms and key pathophysiological domains. Reliance on symptom scores alone creates a diagnostic gap in primary care, underscoring the urgent need for accessible point-of-care tools to achieve precision medicine at the frontline of asthma care.
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