Evidence mapPaperPMID 41622158Full record

ArticleBMC pulmonary medicine2026

Beyond symptoms: uncovering type 2 inflammation and small airway dysfunction in Treatment-Naïve asthma.

Yutaka Nakano, Rika Nakano, Takuya Yukawa, Akihiro Arita

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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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4 · The record

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5 · Who and what money

Authors and funding

4 authors.

Yutaka NakanoNakano Respiratory and Allergy Clinic, 381-2 Hatsuoi-cho, Chuo Ward, Hamamatsu, Shizuoka, 433-8112, Japan. ynakano.asthma@gmail.com.
Rika NakanoNakano Respiratory and Allergy Clinic, 381-2 Hatsuoi-cho, Chuo Ward, Hamamatsu, Shizuoka, 433-8112, Japan.
Takuya YukawaAOI Pharmacy, 381-8 Hatsuoi-cho, Chuo Ward, Hatsuoiten, Hamamatsu, 433-8112, Shizuoka, Japan.
Akihiro AritaAOI Pharmacy, 381-8 Hatsuoi-cho, Chuo Ward, Hatsuoiten, Hamamatsu, 433-8112, Shizuoka, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

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.

Indexed as

AsthmaInflammationAdultEosinophilsFemaleForced Expiratory VolumeFractional Exhaled Nitric Oxide TestingHumansLogistic ModelsMaleMiddle AgedPhenotypeRetrospective StudiesROC CurveSpirometrySurveys and Questionnaires

Identifiers

PMID41622158
PMCPMC12997940

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.