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. 2025 Sep;62(9):1512-1524.
doi: 10.1080/02770903.2025.2493134. Epub 2025 May 15.

Distinct characteristics of asthma overlap phenotypes: Insights from the Turkish adult asthma registry

Secil Kepil Ozdemir  1   2 , Bilun Gemicioglu  3 , Fusun Yildiz  4   5 , Serhat Hayme  6 , Gulistan Alpagat  7 , Nurgul Bozkurt  8 , Ismet Bulut  9 , Munevver Erdinc  10 , Gul Karakaya  11 , Metin Keren  9 , Gulden Pacaci Cetin  12 , Insu Yilmaz  12 , Arzu Yorgancioglu  13 , Omur Aydin  14 , Derya Gokmen  15 , Gozde Koycu Buhari  16 , Zeynep Celebi Sozener  14   17 , Sengul Beyaz  17   18 , Cihan Orcen  19 , Ebru Damadoglu  11 , Tugce Yakut  20 , Ayse Fusun Kalpaklioglu  7 , Ayse Baccioglu  7 , Sumeyra Alan Yalim  7 , Ilkay Koca Kalkan  16 , Mehmet Atilla Uysal  21 , Elif Yelda Ozgun Niksarlioglu  21 , Ali Fuat Kalyoncu  11 , Muge Erbay  22 , Sibel Nayci  23 , Fatma Merve Tepetam  9 , Aslı Gelincik  18 , Hulya Dirol  8 , Ozlem Goksel  24 , Selen Karaoglanoglu  25 , Ferda Oner Erkekol  26   27 , Sacide Rana Isik  28 , Yasemin Yavuz  15 , Dilek Karadogan  29 , Ummuhan Seker  30 , Ipek Kivilcim Oguzulgen  31 , Ilknur Basyigit  4 , Serap Argun Baris  4 , Elif Yilmazel Ucar  32 , Tuba Erdogan  33 , Mehmet Polatli  34 , Dane Ediger  35 , Fatma Esra Gunaydin  35 , Murat Turk  12   36 , Leyla Pur  37 , Zeynep Yegin Katran  9 , Yonca Sekibag  3 , Enes Furkan Aykac  3 , Dilsad Mungan  14 , Ozcan Gul  14 , Ali Cengiz  14 , Bulent Akkurt  1 , Seyma Ozden  9 , Semra Demir  18 , Derya Unal  18 , Ayse Feyza Aslan  18 , Ali Can  18 , Reyhan Gumusburun  24 , Gulhan Bogatekin  24 , Hatice Serpil Akten  24 , Sinem Inan  24 , Aliye Candan Ogus  8 , Murat Kavas  38 , Demet Polat Yulug  39 , Mehmet Erdem Cakmak  11 , Saltuk Bugra Kaya  11 , Eylem Sercan Ozgur  23 , Oguz Uzun  40 , Sule Tas Gulen  34 , Gulseren Pekbak  35 , Deniz Kizilirmak  13 , Yavuz Havlucu  13 , Halil Donmez  41 , Bahar Arslan  12 , Sadan Soyyigit  26 , Bilge Yilmaz Kara  29 , Gulden Pasaoglu Karakis  42 , Adile Berna Dursun  41   43 , Resat Kendirlinan  44 , Ayse Bilge Ozturk  45 , Can Sevinc  46 , Gokcen Omeroglu Simsek  46 , Oznur Abadoglu  47 , Pamir Cerci  48 , Taskin Yucel  49 , Irfan Yorulmaz  50 , Zahide Ciler Tezcaner  50 , Emel Cadalli Tatar  51 , Ahmet Emre Suslu  49   52 , Serdar Ozer  49 , Engin Dursun  53 , Gulfem Elif Celik  14
Affiliations

Distinct characteristics of asthma overlap phenotypes: Insights from the Turkish adult asthma registry

Secil Kepil Ozdemir et al. J Asthma. 2025 Sep.

Abstract

Introduction: Considerable overlaps exist between asthma phenotypes and the clinical significance of these overlaps remains undetermined. The objective of this study is to analyze the characteristics of asthma overlap phenotypes using data from the Turkish Adult Asthma Registry (TAAR).

Methods: This cross-sectional registry study included 2053 adult patients (74.8% female) with asthma.

Results: Overall, 39.3% (n = 697) had allergic-eosinophilic (AE), 26.0% (n = 461) had allergic-non-eosinophilic (ANE), 21.3% (n = 377) had non-allergic-eosinophilic (NAE), and 13.4% (n = 237) had non-allergic-non-eosinophilic (NANE) asthma. Severe asthma exacerbations and emergency department (ED) visits were more frequent in the AE (28.3%, 31.2%, respectively) and NAE groups (36.0%, 34.0%, respectively) than in the ANE (14.3%, 20.6%, respectively) and NANE groups (12.6%, 16.7%, respectively) (p < 0.001). FEV1 values were significantly lower in the AE group than in the ANE and NANE groups (p < 0.001, p = 0.048, respectively) and in the NAE group than in the ANE group (p < 0.001). Risk factors for poor asthma control included living in rural areas, asthma-related ED visits, FEV1 < 60% in the NAE; being overweight, chronic rhinosinusitis, oral corticosteroids use, age < 40 years in the NANE; FEV1 < 80% in the AE; and severe asthma exacerbations, ED visits for AE and ANE groups.

Conclusion: The considerable overlap between allergic and eosinophilic asthma phenotypes has clinical implications as increased rates of asthma exacerbations and healthcare utilization. The clinical heterogeneity among asthma phenotypes based on a single biomarker highlights the importance of multidimensional asthma phenotyping.

Keywords: Allergic asthma; eosinophilic asthma; non-allergic asthma; non-eosinophilic asthma; overlap; uncontrolled asthma.

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