The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Association between primary immunodeficiency and asthma exacerbation in adult asthmatics

  • Lee, So-Hee (Department of Allergy and Clinical Immunology, Ajou University School of Medicine) ;
  • Ban, Ga-Young (Department of Pulmonology and Allergy, Hallym University Kangdong Sacred Heart Hospital) ;
  • Kim, Su-Chin (Department of Statistics, Clinical Trial Center, Ajou University Medical Center) ;
  • Chung, Chang-Gyu (Division of Allergy & Clinical Immunology, Department of Internal Medicine, Keimyung University Dongsan Medical Center) ;
  • Lee, Hyun-Young (Department of Statistics, Clinical Trial Center, Ajou University Medical Center) ;
  • Lee, Ji-Ho (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Park, Hae-Sim (Department of Allergy and Clinical Immunology, Ajou University School of Medicine)
  • Received : 2018.11.20
  • Accepted : 2019.02.18
  • Published : 2020.03.01
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Abstract

Background/Aims: Primary immunodeficiency (PID) is a serious comorbid condition in adult asthmatics that have frequent exacerbations, which requires monthly replacement of intravenous immunoglobulin (IVIG). However, the prevalence and clinical significance of PID in adult asthmatics in Korea have not yet been reported. The aim of this study is to assess the prevalence of PID and its association with asthma exacerbation in Korean adult asthmatics. Methods: A total of 2,866 adult asthmatics were enrolled in this study. The PID group was defined as subjects who had lower levels of immunoglobulin G (IgG)/A/M and/or IgG subclass presenting with recurrent respiratory infections. Serum samples were assayed for total IgG/A/M by immunoturbidimetry, and IgG subclasses by nephelometry. Results: Of the 2,866 asthmatic patients enrolled, 157 (5.49%) had PID (classified as the PID group), while those without PID was classified as the non-PID group. IgG subclass deficiency (58%) is most prevalent, among which IgG3 subclass deficiency was most common (58%). The relative risk of asthma exacerbation was 1.70 times higher in the PID group compared to the non-PID group (1.696; 95% confidence interval, 1.284 to 2.239; p < 0.001); the prevalence of severe asthma was significantly higher in the PID group than in the non-PID group (32.48% vs. 13.00%, p < 0.001). Thirty-five among 157 patients in the PID group d maintained IVIG to prevent asthma exacerbation. Conclusions: It is suggested that PID, especially IgG3 subclass deficiency, is a significant risk factor for asthma exacerbation. Screening of IgG subclass levels and IVIG replacement should be considered in the management in adult asthmatics.

Keywords

Acknowledgement

This study was supported by Green Cross Corp. and by a grant from the Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI16C0992).

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