Clinical phenotyping of asthma patients with elevated sputum eosinophils and low blood eosinophils: a post-hoc analysis of the multicentre ATLANTIS cohort.

Authors

Pauline J M Kuks, Atheer M A Aabed, Lauren C A Premereur, Monica Kraft, Salman Siddiqui, Leonardo M Fabbri, Bianca Beghé, Klaus F Rabe, Alberto Papi, Christopher E Brightling, Dave Singh, Alessio Piraino, Ulrica Scaffidi-Argentina, Janwillem H Kocks, Lies Lahousse, Huib A M Kerstjens, Irene H Heijink, Simon D Pouwels, Dirk-Jan Slebos, Maarten van den Berge

Published in

EBioMedicine. Volume 130. Pages 106366. Jul 11, 2026. Epub Jul 11, 2026.

Abstract

Patients with eosinophilic asthma are responsive to treatment with corticosteroids and biologics. Eosinophilia is usually identified based on blood eosinophil counts, but there is discordance between blood and sputum in some cases. A subset of patients may have sputum eosinophilia despite low blood eosinophil levels. The clinical implications of this so-called isolated sputum eosinophilia are unknown. The aim of this study is to investigate the clinical expression of asthma in patients with isolated sputum eosinophilia.
In this post-hoc ATLANTIS analysis we included patients with available blood and/or sputum data from ATLANTIS. Patients were classified according to blood eosinophils (< or ≥300 cells/μL). Patients with isolated sputum eosinophilia were compared with those with low eosinophils in both compartments.
Of the 487 patients with low blood eosinophils counts, sputum samples were available in 146. Among these, 25 (17%) had isolated sputum eosinophilia. Compared with patients with low eosinophils in both compartments (n = 121), patients with isolated sputum eosinophilia had more airflow obstruction (FEV₁/FVC ratios (68.8% vs. 75.4%, p <0.01)) and small airways dysfunction (S_cond0.05 vs. 0.03 1/L, p = 0.02) and more frequently reported exacerbations in the year prior to inclusion (28% vs. 9%, p = 0.01). Clinical characteristics were broadly comparable to those observed in patients with blood eosinophilia.
Isolated sputum eosinophilia occurs in a subgroup of patients with asthma, in association with worse clinical outcomes. These findings suggest that airway eosinophilia may not always be captured by conventional blood biomarkers and warrant further investigation into the clinical implications of this phenotype to determine whether these patients may benefit from treatment strategies targeting type 2 inflammation, such as intensified steroids or biologics.
Chiesi Farmaceutici sponsored the ATLANTIS study.

PMID:
42435581
Bibliographic data and abstract were imported from PubMed on 12 Jul 2026.

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