| Title: |
Small airways dysfunction and remission in adults with asthma:A longitudinal exploratory analysis of the AssessmenT of smalL Airways involvemeNT In aSthma (ATLANTIS) study |
| Authors: |
Kumar, Akshi; Chan, Rory; Zounemat-Kermani, Nazanin; Quek, Eleanor; Addock, Ian M.; Beghe, Bianca; Brightling, Christopher; Singh, Dave; Kocks, Janwillem; Papi, Alberto; Rabe, Klaus F; Scaffidi-Argentina, Ulrica; van den Berge, Maarten; Kraft, Monica; Siddiqui, Salman |
| Source: |
Kumar, A, Chan, R, Zounemat-Kermani, N, Quek, E, Addock, I M, Beghe, B, Brightling, C, Singh, D, Kocks, J, Papi, A, Rabe, K F, Scaffidi-Argentina, U, van den Berge, M, Kraft, M & Siddiqui, S 2026, 'Small airways dysfunction and remission in adults with asthma : A longitudinal exploratory analysis of the AssessmenT of smalL Airways involvemeNT In aSthma (ATLANTIS) study', Allergy. https://doi.org/10.1111/all.70264 |
| Publication Year: |
2026 |
| Collection: |
Discovery - University of Dundee Online Publications |
| Subject Terms: |
asthma; disease exacerbation; factor analysis; gene expression analysis; remission induction; spontaneous remission; /dk/atira/pure/subjectarea/asjc/2700/2723; name=Immunology and Allergy; /dk/atira/pure/subjectarea/asjc/2400/2403; name=Immunology |
| Description: |
Background: Asthma remission is a feasible treatment goal. However, remission definitions vary, and predictive biomarkers remain underexplored. Methods: We conducted a post hoc analysis of ATLANTIS (NCT02123667), a multinational prospective study including 684 adult asthmatics. Remission was defined by 3-component (3C) and 4-component (4C) criteria. 3C remission included: (1) ACQ-6 < 1.5, (2) no maintenance oral corticosteroids, (3) no exacerbations. An absolute decline < 10% in pre-bronchodilator FEV 1 % predicted, was added for the 4C definition. Multivariate logistic regression identified remission predictors. A novel Low Disease Activity (LDA) score was developed using factor analysis of five clinical variables (ACQ-6, FeNO, BEC, and FEV 1 ) including an innovative small airways dysfunction questionnaire tool (SADT). Nasal transcriptomics were analysed for differential gene expression and pathway enrichment and were replicated in U-BIOPRED (NCT01976767) using sputum transcriptomics. U-BIOPRED was included only to study omics replication of remission pathways identified in ATLANTIS. Findings: Remission occurred in 48% (3C) and 45% (4C) of patients. Predictors included male sex, better lung function, fewer previous exacerbations, and higher SADT (fewer small airways symptoms). LDA identified milder disease and was associated with remission [OR 3C 4.43 (2.80, 7.10) and 4C 3.46 (2.23, 5.43)], improved QoL [OR 2.07 (1.65, 2.60)], and fewer future exacerbations [OR 0.43 (0.22, 0.85)]. Transcriptomic analyses revealed remission-associated upregulation of interleukin 4/13 signalling and downregulation of coagulation pathways, in both ATLANTIS and U-BIOPRED. Interpretation: SAD was associated with reduced asthma remission. A novel LDA tool demonstrated clinical utility in stratifying prospective asthma risk. Key immunologic and haemostatic pathways may underpin remission, offering potential targets for future intervention. |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| ISSN: |
0105-4538; 1398-9995 |
| Relation: |
info:eu-repo/semantics/altIdentifier/pissn/0105-4538; info:eu-repo/semantics/altIdentifier/eissn/1398-9995 |
| DOI: |
10.1111/all.70264 |
| Availability: |
https://discovery.dundee.ac.uk/en/publications/7e8cd372-4ee6-4b07-a0ea-460b55b2958c; https://doi.org/10.1111/all.70264; https://discovery.dundee.ac.uk/ws/files/164997405/Allergy_-_2026_-_Kumar_-_Small_Airways_Dysfunction_and_Remission_in_Adults_With_Asthma_A_Longitudinal_Exploratory_Analysis_1_.pdf; https://www.scopus.com/pages/publications/105030566368 |
| Rights: |
info:eu-repo/semantics/openAccess ; http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.C685B2A7 |
| Database: |
BASE |