Clinical remission and lung function trajectories among the T2 asthma phenotypes

<bold>Rationale:</bold> The nature and course of T2-inflammation may indicate differences in asthma outcomes <bold>Objective:</bold> To investigate the association of T2-phenotypes with lung function trajectories and clinical remission <bold>Methods:</bold> We defined T2-inflammation according to GINA guidelines. Adult asthmatics were stratified based on T2-markers and percentage of induced sputum granulocytes into T2-subtle (eosinophils <2%), T2-dominant (eosinophils > 2% and neutrophils <50%), and T2-mixed (eosinophils >2% and neutrophils >50%). We defined clinical remission as an ACT score >20 with absence of severe exacerbations and systemic steroid use, FEV1 decline of ≤100 ml in the past 12 months. We performed spirometry, oscillometry and body plethysmography. Lung function and remission were assessed after 1 and 4 years (FU 1y, FU 4y) <bold>Results:</bold> 92% of the patients (n = 206) had T2-inflammation. Of patients with available sputa (n = 157), the frequency of T2-dominant, T2-mixed and T2-subtle was 26%, 25% and 49%, respectively. Clinical remission occurred at FU1 in 0%, 20% and 35% (p = 0.025) and at FU4 in 0%, 25% and 32%, (p = 0.23), of patients with T2-dominant, T2-mixed and T2-subtle, respectively. Markers of central and peripheral airway obstruction were constantly and significantly worst in patients with T2-mixed (Figure 1) <bold>Conclusion:</bold> In T2-asthma, isolated airway eosinophilia indicates poor clinical remission, whereas a mixed phenotype indicates airway remodeling. <fig><object-id>erj;64/suppl_68/PA1192/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>