The triple type 2 signature is associated to asthma severity and comorbidity with nasal polyps

Type 2 (T2) high asthma includes different clnical phenotypes of asthma, but the prevalence and impact of severity and comorbidities is unknown. This process is specially important because biologics indication for severe asthma usually depends on the underlying T2 pheno-endotypic signature. <bold>Objective:</bold> To describe the level of coexpression of clinically available T2 inflammatory biomarkers, in patients with asthma and the reltionship with asthma severity and sinonasal comorbidities. <bold>Methods:</bold> 492 asthma patients, mean age 46 (33-58) years old, 70% females, by GINA asthma severity classification: 17.3% intermittent and 82,7% persistent (24.6% mild, 31.4% moderate and 26.7% severe), were evaluated for upper airways comorbidity according to ARIA and EPOS international guidelines criteria. Identification of type 2 was evaluated according to T2 biomarkers: blood eosinophilia (>300 cels/mcL), Total IgE>100 IU/mL) and fractional exhaled nitric oxide (FeNO>25 ppb). <bold>Results:</bold> We found 401 (81.5%) of the 492 patients to have at least one biomarker elevated. Out of them we selected the 207 (42%) patients with all the three biomarkers recorded. Expression patterns of the T2 biomarkers were associated with differences in asthma severity (intermittent 17.9%, mild 19.5%, moderate 25.4% and severe 26.6%; p=0.106) and with the different upper airways comorbidities (no sinonasal disease 20%, NAR 5.6%, AR 16.7%, CRSsNP 33.3% and CRSwNP 37.9%; p<0.001). Asthma with CRSwNP showed the highest values of each biomarker (p<0.001), even total IgE despite the presence of atopy. <bold>Conclusions:</bold> Coexpression of T2 biomarkers with triple T2 signature is associated with severe asthma and CRS comorbidity.