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This is probably a consequence of airway remodelling, but neither its relation to inflammation nor which asthma biomarkers can be clinically useful are elucidated. We hypothesized that the presence of type 2 inflammation relates to fixed\u2010<jats:styled-content style=\"fixed-case\">AO<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To evaluate the presence of four markers for type 2 inflammation in fixed airflow obstruction among asthmatics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a cross\u2010sectional study of 403 participants with asthma, aged 17\u201075\u00a0years, from three Swedish centres. Fixed airflow obstruction was defined as forced expiratory volume during the first second (<jats:styled-content style=\"fixed-case\">FEV<\/jats:styled-content><jats:sub>1<\/jats:sub>) over forced vital capacity (<jats:styled-content style=\"fixed-case\">FVC<\/jats:styled-content>) being below the lower limit of normal (<jats:styled-content style=\"fixed-case\">LLN<\/jats:styled-content>). The following type 2 inflammation markers were assessed: exhaled nitric oxide (Fe<jats:styled-content style=\"fixed-case\">NO<\/jats:styled-content>), serum periostin, serum eosinophil cationic protein (S\u2010<jats:styled-content style=\"fixed-case\">ECP<\/jats:styled-content>), and urinary eosinophil\u2010derived neurotoxin (U\u2010<jats:styled-content style=\"fixed-case\">EDN<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Elevated U\u2010<jats:styled-content style=\"fixed-case\">EDN<\/jats:styled-content> (values in the highest tertile, \u226565.95\u00a0mg\/mol creatinine) was more common in subjects with fixed\u2010<jats:styled-content style=\"fixed-case\">AO<\/jats:styled-content> vs. subjects without fixed\u2010<jats:styled-content style=\"fixed-case\">AO<\/jats:styled-content>: 55% vs. 29%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001. Elevated U\u2010<jats:styled-content style=\"fixed-case\">EDN<\/jats:styled-content> related to increased likelihood of having fixed\u2010<jats:styled-content style=\"fixed-case\">AO<\/jats:styled-content> in both all subjects and never\u2010smoking subjects, with adjusted (adjusted for sex, age group, use of inhaled corticosteroids last week, atopy, early\u2010onset asthma, smoking history, and packyears) odds ratios (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>) of 2.38 (1.28\u20104.41) and 2.51 (1.04\u20106.07), respectively. In a separate analysis, having both elevated S\u2010<jats:styled-content style=\"fixed-case\">ECP<\/jats:styled-content> (&gt;20\u00a0\u03bcg\/L) and U\u2010<jats:styled-content style=\"fixed-case\">EDN<\/jats:styled-content> was related to having the highest likelihood of fixed\u2010<jats:styled-content style=\"fixed-case\">AO<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>) 6.06 (2.32\u201015.75)). Elevated serum periostin or Fe<jats:styled-content style=\"fixed-case\">NO<\/jats:styled-content> did not relate to fixed\u2010AO.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and clinical relevance<\/jats:title><jats:p>These findings support that type 2 inflammation, and in particular eosinophil inflammation, is found in asthma with fixed\u2010<jats:styled-content style=\"fixed-case\">AO<\/jats:styled-content>. This could indicate a benefit from eosinophil\u2010directed therapies. Further longitudinal studies are warranted to investigate causality and relation to lung function decline.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cea.13302","type":"journal-article","created":{"date-parts":[[2018,10,26]],"date-time":"2018-10-26T15:55:33Z","timestamp":1540569333000},"page":"155-162","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Fixed airflow obstruction relates to eosinophil activation in asthmatics"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0198-2718","authenticated-orcid":false,"given":"Ida","family":"Mogensen","sequence":"first","affiliation":[{"name":"Department of Medical Sciences Lung Allergy and Sleep research Uppsala University Uppsala Sweden"},{"name":"Department of Medical Sciences Clinical Physiology Uppsala University Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kjell","family":"Alving","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Uppsala University Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sven\u2010Erik","family":"Dahlen","sequence":"additional","affiliation":[{"name":"Experimental Asthma and Allergy Research National Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"James","sequence":"additional","affiliation":[{"name":"Experimental Asthma and Allergy Research National Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bertil","family":"Forsberg","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine Occupational and Environmental Medicine Ume\u00e5 University Ume\u00e5 Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junya","family":"Ono","sequence":"additional","affiliation":[{"name":"Shino\u2010Test Corporation Ltd. 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