INTRODUCTION

Asthma is a heterogeneous disease, usually characterised by chronic airway inflammation. This chronic inflammation is characterised by airway symptoms such as wheezing, shortness of breath, and cough that vary over time and intensity, accompanied by expiratory airflow limitation.[1]

According to the World Health Organization (WHO) and the Global Initiative for Asthma (GINA), the number of asthma sufferers globally reaches 300 million people, and this figure is expected to grow to 400 million by 2025. Based on data from the Ministry of Health in 2020, Asthma is one of the most common diseases suffered by Indonesians; until the end of 2020, the number of asthma sufferers in Indonesia was 4.5 percent of the total population of Indonesia or more than 12 million.[1,2] In patients with asthma on medication, the severity of asthma is assessed based on the clinical features of asthma and the treatment regimen. According to the Global Initiative for Asthma (GINA), asthma management guidelines aim to achieve controlled asthma. However, in reality, the guidelines are not implemented effectively in daily practice, so there are still many uncontrolled asthma conditions.[1] Various factors play a role in causing uncontrolled asthma, including age, gender, education level, smoking habit, severe asthma, incorrect use of corticosteroid drugs, genetics, comorbid diseases, poor treatment compliance, lack of knowledge about asthma, and excess weight. Asthma can occur at any age, with highly variable manifestations that vary from one individual to another (Global Initiative for Asthma (GINA).[3]

The inflammation that occurs in asthma is a typical inflammation accompanied by eosinophil infiltration, which distinguishes asthma from other airway inflammatory disorders. Eosinophils are the main inflammation in asthma; it is proven that after inhalation with allergens, there is an increase in eosinophils in bronchoalveolar drain fluid during slow asthmatic reactions accompanied by inflammation.[3] Based on the background obtained, the formulation of this research problem is as follows: How is Blood Eosinophil Level a predictor of Asthma Exacerbation?

METHOD

This study is a type of analytic observational research with a retrospective cohort approach based on medical records. This research was conducted at Prof. Dr. Chairuddin P. Lubis USU Hospital. The population of this study consisted of patients with stable asthma who were controlled at the pulmonary polyclinic based on anamnesis, physical examination, and supporting examination. The number of patients required based on the calculation for the hypothesis of different proportions is 25. Inclusion criteria are patients who have received ICS-LABA inhaler therapy for one year, and exclusion criteria are patients who lost to follow-up.

Collected data will be processed using statistical software. Data will be processed and analysed descriptively to evaluate the frequency distribution of research subjects based on characteristics. Data were analysed using the spss version 26 application, and the Whitney test was used to see the relationship between eosinophil levels and asthma exacerbation levels.

RESULTS

Based on Table 1, it can be seen that the age of asthma patients is mostly in the age category 26-50 years, with as many as 11 patients (44%), then age> 50 years, as many as 8 people (32%) and the least is the age category 15-25 years as many as 6 people (24%). Then asthma patients are more dominantly female, as many as 20 people (80%), and men, as many as 5 people (20%).

Table 1. Demographic Characteristics of Asthma Patients at RS Prof. Dr Chairuddin P Lubis USU

Based on Table 2, it can be seen that patients with eosinophil levels <100 are the most patients, namely 21 people (84%), then patients with eosinophil levels 100-300 and patients with eosinophil levels >300 each as many as 2 people (8%).

Table 2 Overview of Eosinophil Levels in Asthma Patients at Prof. Dr. Chairuddin P Lubis USU Hospital

Table 3 shows that asthma patients with severe exacerbation were 18 people (72%), and asthma patients with mild to moderate exacerbation were 7 people (28%).

Table 3. Overview of the Exacerbation Level of Asthma Patients at Prof. Dr. Chairuddin P Lubis USU Hospital

Based on Table 4, a P value of 0.976 was obtained. Since the P value is greater than 0.05, there is no relationship between eosinophil levels and the exacerbation level of asthma patients at the USU Hospital polyclinic.

Table 4. Relationship Between Eosinophil Levels and the Level of Exacerbation of Asthma Patients at the Lung Polyclinic of the USU Hospital

DISCUSSION

Based on the results of the study, it can be seen that the age of most asthma patients is in the 26-50 age category, with 11 patients (44%), then over 50 years of age with 8 people (32%) and the least is the 15-25 age category with 6 people (24%). This is in line with Lorensia's research which shows that patients aged 25-49 years are the most numerous, with 34 people (79%), and patients aged 20-24 years with 9 people (21%)18.

Then asthma patients are more predominantly female, with 20 people (80%), and male with 5 people (20%). This is in line with Lorensia's research, that there are more female patients, 26 (60.47%), and male patients, 17 (39.53%).[4] After puberty, asthma becomes more common and severe in women than in men. This shift is associated with hormonal changes and other biological factors that occur during puberty and throughout a woman's life, such as menstruation, pregnancy, and menopause.[5,6] In the UK Severe Asthma Registry, 60.9% of severe asthma patients are women, highlighting the higher prevalence of severe asthma among women.[7,8]

Based on the results of the study, it can be seen that patients with eusinophil levels <100 are the most numerous, namely 21 people (84%), then patients with eusinophil levels of 100-300 and patients with eusinophil levels >300, 2 people each (8%). This is in line with Fachri's research which states that the highest level of eosinophils in asthma patients is <350 eosinophils in 60 people (57.1%), and >350 eosinophils in 45 people (42.9%).[9] The number of eosinophils is higher in patients with more severe asthma. For example, one study found that the number of eosinophils was significantly higher in patients with severe asthma compared to mild and moderate cases, with a total of 658±72 eos/mm³ in severe cases versus 334±35 eos/mm³ in mild cases.[10] Eosinophil levels can vary significantly in people with asthma, affecting treatment decisions. In a study of people with severe asthma, only 6% consistently had eosinophil levels above 300 cells/μL, indicating the need for repeated measures to guide therapy.[11]

Based on the results of the study, it was found that 18 people (72%) were asthma patients with a severe level of exacerbation, and 7 people (28%) were asthma patients with a mild to moderate level of exacerbation. This is not in accordance with Muhammad's research which states that the highest level of exacerbation is moderate exacerbation with 38 people (71.7%), mild exacerbation with 12 people (22.6%), and severe exacerbation with 3 people (5.7%).[12] In the United States, the CHRONICLE study found that female, black, Hispanic, and younger adult patients experience higher rates of severe asthma exacerbations compared to their peers.[13]

Based on the results of the study, a P value of 0.976 was obtained. Since the P Value is greater than 0.05, there is no relationship between eosinophil levels and the level of exacerbation of asthma patients at the USU Hospital polyclinic. In the results of this study, low eosinophil levels in asthma patients were found due to several possibilities, including 1) decreased peripheral blood eosinophils, 2) the use of corticosteroids, both inhaled and systemic, 4-8 hours before the attack, 3) peripheral blood eosinophils have not increased during the attack because of the slow immune response phase that occurs 6-8 hours after bronchoconstriction, and 4) there is asthma that does not go through a mechanism involving eosinophils, known as non-eosinophilic asthma, but is related to a neutrophil response. Eosinophil levels can predict clinical outcomes, such as the risk of acute exacerbation. In the Korean cohort, patients with eosinophil levels <100 cells/μL had a higher risk of severe exacerbation, while patients with levels ≥300 cells/μL had a higher risk of moderate exacerbation.[14] Exposure to bacterial endotoxins, air pollution, and viral infections can trigger neutrophil infiltration in asthma. If the patient has non-eosinophilic asthma, then an examination of the peripheral blood will not show an increase in the number of eosinophils or eosinophilia, so there is no relationship between the level of eosinophils and the level of exacerbation.[15]

CONCLUSION

This study shows that most asthma patients are in the 26-50 age group (44%) and predominantly female (80%). Most patients have eosinophil levels <100 (84%), while severe exacerbations are the most common (72%). However, statistical analysis indicates no significant relationship between eosinophil levels and the severity of asthma exacerbations (p = 0.976).

This suggests that other factors, such as corticosteroid use, delayed immune response, and the possibility of non-eosinophilic asthma, may influence this relationship. These findings highlight the importance of a multidimensional evaluation in asthma management, including identifying different asthma phenotypes for a more precise therapeutic approach.

DECLARATIONS

Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Address: Jalan Dr. T. Mansur No.9, Padang Bulan, Kec. Medan Baru, Kota Medan, Sumatera Utara

CONSENT FOR PUBLICATION

The Authors agree to publication in Journal of Society Medicine.

FUNDING

None

COMPETING INTERESTS

The authors declare that there is no conflict of interest in this report.

AUTHORS’ CONTRIBUTIONS

All authors significantly contribute to the work reported execution, acquisition of data, analysis, and interpretation, or in all these areas. Contribute to drafting, revising, or critically reviewing the article. Approved the final version to be published, agreed on the journal to be submitted, and agreed to be accountable for all aspects of the work.

ACKNOWLEDGMENTS

None

REFERENCE

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