A32-21 Exploring Personalized Treatment Targets Based on Symptom Phenotyping in Asthma

Rationale Asthma management is shifting from symptom control to clinical remission (CR), yet Asthma Control Test (ACT) may overlook cough, potentially misclassifying patients as well-controlled. Objective To identify distinct symptom-based asthma phenotypes using ACT and the Leicester Cough Questionnaire (LCQ), and to explore their inflammatory profiles, comorbidities, and remission potential. Methods In this post-hoc analysis of 387 asthma patients (including 30 COPD patients, mean age 61.1 years, 239 females [61.8%]) from the multicenter REACTION Study, participants were classified into four phenotypes based on ACT and LCQ scores: well-controlled (W: ACT ≥20, LCQ ≥17.68; n = 232), cough-predominant (C: ACT ≥20, LCQ <17.68; n = 52), dyspnea-predominant (D: ACT <20, LCQ ≥17.68; n = 24), and poorly-controlled (P: ACT <20, LCQ <17.68; n = 79). Clinical characteristics, biomarker profiles, comorbidities, and deep remission rates were compared. Results Despite ACT-defined control, 18.3% of patients had impaired cough-specific QoL. Each phenotype exhibited distinct features: the C group showed higher rates of GERD and bronchiectasis; the D group had the lowest FEV1 and highest airflow limitation; the P group demonstrated non-Type-2 inflammation (neutrophilic predominance), psychiatric comorbidities, and poor outcomes. Deep remission, defined by biomarker suppression, preserved lung function, and absence of exacerbations/systemic steroids, was achieved in only 30 patients (7.8% of whole). Conclusions Combined ACT and LCQ assessment enables identification of asthma phenotypes with unique therapeutic needs. Cough remains under-recognized in ACT-defined well-controlled asthma, and phenotype-specific strategies targeting comorbidities and inflammatory patterns are essential for achieving asthma control. Routine LCQ use in combination with ACT may enhance personalized asthma care and optimize long-term outcomes. This abstract is funded by: A Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sport, Science and Technology (MEXT; 24K11373)