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Qu Y, Wang L, Liu J. Evaluating the clinical utility of small airway function assessment for early diagnosis of GOLD stage 0 chronic obstructive pulmonary disease. J Asthma 2024:1-7. [PMID: 38880950 DOI: 10.1080/02770903.2024.2368178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To investigate the clinical utility of small airway function indices for early identification of GOLD stage 0 chronic obstructive pulmonary disease (COPD). METHODS This retrospective study enrolled 137 participants at our institution between January 2017 and December 2018, comprising 40 healthy controls, 46 individuals with GOLD stage 0 COPD, and 51 patients with established COPD. Pulmonary function was assessed using the PowerCube spirometry system (GANSHORN, Germany). Parameters evaluated included forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, and small airway function indicators. RESULTS The COPD cohort exhibited significantly lower values across all lung function measures compared to the other two groups, particularly for dynamic lung volume parameters such as FEV1%predicted and FEV1/FVC%. Small airway function indices, including FEV3%predicted, FEF75%predicted, FEF50%predicted, FEF25%predicted, and MMEF%predicted, were markedly decreased in the COPD group (all p-values <0.001). Receiver operating characteristic (ROC) curve analysis demonstrated that MMEF/FVC% and FEV3/FVC% had high diagnostic accuracy for COPD, with MMEF/FVC% exhibiting the optimal sensitivity and specificity. CONCLUSION Small airway function indices, especially MMEF/FVC%, can serve as effective tools for early identification of GOLD stage 0 COPD. Incorporation of these findings into clinical practice may facilitate early diagnosis and intervention, thereby improving treatment outcomes and patient quality of life.
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Affiliation(s)
- Yanhua Qu
- General Department of Datuan Community Health Service Center, Shanghai, China
| | - Lixia Wang
- General Department of Datuan Community Health Service Center, Shanghai, China
| | - Jinming Liu
- Department of Pulmonary Circulation, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, China
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Mümmler C, Mertsch P, Barnikel M, Haubner F, Schönermarck U, Grabmaier U, Schulze-Koops H, Behr J, Kneidinger N, Milger K. Benralizumab Reduces Respiratory Exacerbations and Oral Glucocorticosteroid Dose in Patients with Severe Asthma and Eosinophilic Granulomatosis with Polyangiitis. J Asthma Allergy 2024; 17:557-572. [PMID: 38860030 PMCID: PMC11164095 DOI: 10.2147/jaa.s461800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
Background Benralizumab reduces exacerbations and long-term oral glucocorticosteroid (OCS) exposure in patients with severe eosinophilic asthma. In patients with eosinophilic granulomatosis with polyangiitis (EGPA), uncontrolled symptoms and exacerbations of asthma and chronic rhinosinusitis (CRS) are important reasons for continued OCS therapies. We aimed to describe outcomes of patients with severe asthma and EGPA treated with benralizumab in real-life. Methods We retrospectively analyzed adult patients from the Severe Asthma Unit at LMU Munich diagnosed with severe asthma and EGPA treated with benralizumab, differentiating two groups: Group A, patients with a stable daily OCS dose and diagnosis of EGPA >6 months ago; and Group B, patients treated with high-dose daily OCS due to recent diagnosis of EGPA <6 months ago. We compared outcome parameters at baseline and 12 months after initiation of benralizumab, including respiratory exacerbations, daily OCS dose, and lung function. Results Group A included 17 patients, all receiving OCS therapy and additional immunosuppressants; 15 patients (88%) continued benralizumab for more than 12 months, demonstrating a significant reduction in daily OCS dose and exacerbations while FEV1 increased. Group B included 9 patients, all with high-dose daily OCS and some receiving cyclophosphamide pulse therapy for life-threatening disease. Benralizumab addition during induction was well tolerated. A total of 7/9 (78%) continued benralizumab for more than 12 months and preserved EGPA remission at the 12-month timepoint. Conclusion In this real-life cohort of patients with severe asthma and EGPA, benralizumab initiation during remission maintenance reduced respiratory exacerbations and daily OCS dose. Benralizumab initiation during remission induction was associated with a high rate of clinical EGPA remission.
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Affiliation(s)
- Carlo Mümmler
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Pontus Mertsch
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Michaela Barnikel
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Frank Haubner
- Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Ulf Schönermarck
- Division of Nephrology, Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Ulrich Grabmaier
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Jürgen Behr
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Nikolaus Kneidinger
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center of Lung Research (DZL), Munich, Germany
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Katrin Milger
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center of Lung Research (DZL), Munich, Germany
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Witte A, Türk Y, Braunstahl GJ. Obesity-related asthma: new insights leading to a different approach. Curr Opin Pulm Med 2024; 30:294-302. [PMID: 38441436 DOI: 10.1097/mcp.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW Obesity is a growing global health threat that significantly contributes to the burden of asthma by increasing the risk of developing asthma and exerting a distinct effect on lung function and inflammation. The treatment of obesity-related asthma is hindered by a poor response to standard asthma treatments, leading to worse asthma control. Weight loss strategies have a significant effect on asthma symptoms but are not feasible for a large proportion of patients, underscoring the need for a better understanding of the pathophysiology and the development of additional treatment options. RECENT FINDINGS Recent literature focusing on pathophysiology particularly delved into nontype 2 inflammatory mechanisms, associations with the metabolic syndrome and small airway impairment. Additionally, several new treatment options are currently investigated, including biologics, weight reduction interventions, and novel antiobesity drugs. SUMMARY Obesity-related asthma is a highly prevalent asthma phenotype for which weight loss strategies currently stand as the most specific treatment. Furthermore, novel pharmacological interventions aiming at metabolic processes are on the way.
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Affiliation(s)
- Adjan Witte
- Department of Pulmonology, Franciscus Gasthuis & Vlietland, The Netherlands
| | - Yasemin Türk
- Department of Pulmonology, Franciscus Gasthuis & Vlietland, The Netherlands
- Dutch Asthma Center Davos, Davos, Switzerland
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Franciscus Gasthuis & Vlietland, The Netherlands
- Department of Pulmonary Disease, Erasmus MC, Rotterdam, The Netherlands
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Maniscalco M, Candia C, Calabrese C, D'Amato M, Matera MG, Molino A, Cazzola M. Impact of biologics on lung hyperinflation in patients with severe asthma. Respir Med 2024; 225:107578. [PMID: 38431058 DOI: 10.1016/j.rmed.2024.107578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND In asthma, inflammation affects both the proximal and distal airways and can cause significant hyperinflation, which is thought to be a major cause of dyspnea. METHODS This is a retrospective observational study evaluating the effect of three months of treatment with different biologic drugs (benralizumab, dupilumab and omalizumab) on pulmonary hyperinflation in a cohort of patients with severe asthma already receiving regular triple inhaled therapy. Changes in RV, RV/TLC ratio, FRC and FRC/TLC ratio were the primary efficacy measures. Secondary outcomes included FEV1, FVC, FEV1/FVC ratio, IC, IC/TLC ratio, asthma control test, the percentage of eosinophils in the blood and fractional FENO. RESULTS Benralizumab led to significant changes (p < 0.001) in RV, RV/TLC, FRC, and FRC/TLC. Dupilumab demonstrated a notable reduction in RV (p = 0.017) and RV/TLC (p = 0.002), but the decreases in FRC and FRC/TLC were merely numerical and not as pronounced as those induced by benralizumab. Omalizumab's positive impact on RV (p = 0.057) and RV/TLC (p = 0.085), as well as FRC (p = 0.202) and FRC/TLC (p = 0.096), was also predominantly numerical, with a tendency towards efficacy, albeit excluding the effect on FRC. Treatment with biologics resulted in improvements in all other lung function parameters assessed and a decrease in FENO levels. CONCLUSION This study, although limited by small sample size, lack of a placebo control, and unbalanced group sizes, suggests that biological agents are effective in reducing lung hyperinflation even after a relatively short treatment.
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Affiliation(s)
- Mauro Maniscalco
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, Telese Terme, Italy
| | - Claudio Candia
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, Telese Terme, Italy
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria D'Amato
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Maria Gabriella Matera
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Molino
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Mario Cazzola
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
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Carpagnano GE, Portacci A, Nolasco S, Detoraki A, Vatrella A, Calabrese C, Pelaia C, Montagnolo F, Scioscia G, Valenti G, D’Amato M, Caiaffa MF, Triggiani M, Scichilone N, Crimi C. Features of severe asthma response to anti-IL5/IL5r therapies: identikit of clinical remission. Front Immunol 2024; 15:1343362. [PMID: 38327518 PMCID: PMC10848329 DOI: 10.3389/fimmu.2024.1343362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/05/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Clinical remission (CliR) achievement has been recognized as a new potential outcome in severe asthma. Nevertheless, we still lack a detailed profile of what features could better identify patients undergoing clinical remission. In this study, we aim to address this issue, tracing a possible identikit of patients fulfilling remission criteria. Methods We enrolled 266 patients with severe eosinophilic asthma (SEA) treated with a 12-month course of anti-IL5/IL5 receptor (IL5r) monoclonal antibodies. Patients with no exacerbation, OCS withdrawal, ACT ≥ 20 and FEV1 ≥ 80% after 1 year of biologic treatment were classified as in clinical remission. Results 30.5% of the enrolled patients achieved remission after biologic administration. CliR group showed a lower number of baseline asthma exacerbations and better lung function parameters, with a trend for higher ACT scores and a less frequent history of a positive skin prick test. CliR achievement was unlikely in presence of a higher BMI, a positive skin prick test, an increased number of asthma exacerbations before biologic treatment, anti-muscarinic administration, and a previous diagnosis of EGPA, bronchiectasis or osteoporosis. In contrast, a better lung function, an increased blood eosinophilic count, the presence of chronic rhinosinusitis with nasal polyps and a more frequent use of reliever therapy predicts remission development. Changes in exacerbations number, OCS use, ACT scores and FEV1% between remittent and non-remittent patients arise at specific follow up timepoints and are positively associated with CliR achievement. Discussion anti-IL5/IL5r biologics can induce CliR in a proportion of patients with SEA. Patients achieving remission demonstrate specific clinical, functional and inflammatory features, as well as a specific moment of improvement in all the CliR items.
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Affiliation(s)
- Giovanna Elisiana Carpagnano
- Department of Translational Biomedicine and Neuroscience, Institute of Respiratory Disease, University “Aldo Moro”, Bari, Italy
| | - Andrea Portacci
- Department of Translational Biomedicine and Neuroscience, Institute of Respiratory Disease, University “Aldo Moro”, Bari, Italy
| | - Santi Nolasco
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Aikaterini Detoraki
- Division of Internal Medicine and Clinical Immunology, Department of Internal Medicine and Clinical Complexity, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Cecilia Calabrese
- Unitá Operativa (UO) Clinica Pneumologica SUN, Dipartimento Pneumologia ed Oncologia, Azienda Ospedaliera Specialistica dei Colli, Napoli, Italy
| | - Corrado Pelaia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Francesca Montagnolo
- Department of Translational Biomedicine and Neuroscience, Institute of Respiratory Disease, University “Aldo Moro”, Bari, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Maria D’Amato
- Unitá Operativa Semplice Dipartimentale (UOSD) Malattie Respiratorie “Federico II”, Ospedale Monaldi, Azienda Ospedaliera (AO) Dei Colli, Naples, Italy
| | - Maria Filomena Caiaffa
- Department of Medical and Surgical Sciences, School and Chair of Allergology and Clinical Immunology, University of Foggia, Foggia, Italy
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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6
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Strauss R, Leflein H, Kolesar A, Hammel J. Long-Term Efficacy and Safety Among Patients With Severe Eosinophilic Asthma Treated With Mepolizumab and Its Effect on Small Airways. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3670-3679.e2. [PMID: 37572752 DOI: 10.1016/j.jaip.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND The major problem at the Cleveland Allergy and Asthma Center was the need for additional therapy for severe eosinophilic asthma patients who were steroid-dependent or required frequent bursts of prednisone. OBJECTIVES The objectives of this study were to determine the efficacy of monthly mepolizumab (MP) injections up to 6½ years using Asthma Control Quesitonnaire-7 (ACQ-7), forced expiratory volume in 1 second (FEV1), forced expiratory flow at 25% to 75% (FEF25%-75%) overall and among super-responders, and to understand whether FEF25%-75% is an effective parameter to evaluate MP efficacy. METHODS We reviewed the charts of 67 patients with severe eosinophilic asthma and compared the results between 47 super-responders and the rest of the cohort regarding ACQ-6, ACQ-7, eosinophils, FEV1, and FEF25%-75%. The groups of super-responders and all other patients were described with respect to initial and current values of the study end points using medians and 25th and 75th percentiles. Changes from the initial to the current values in the study end points were measured using percent changes. The Wilcoxon signed rank test was used within each group to test the null hypothesis of 0 median percent change. RESULTS After 6½ years, there were no significant changes in FEV1. The FEF25%-75%, had a significant median percent increase of 40% among the super-responders (P < .001), which was substantially higher (P = .026) than the median percent increase of 13.8% observed among all other patients. CONCLUSIONS The use of MP up to 6½ years was safe and effective, with significant changes to ACQ-7 and FEF25%-75% associated with MP treatment, but not the FEV1. A higher magnitude of changes was observed among super-responders than the rest of the cohort. Changes in FEF25%-75% were more meaningful than changes in FEV1 in evaluating pulmonary function responsiveness of severe eosinophilic asthma to MP.
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Affiliation(s)
- Ronald Strauss
- Cleveland Allergy and Asthma Center and Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Hannah Leflein
- Case Western Reserve University, Cleveland Allergy and Asthma Center, Cleveland, Ohio
| | - Anna Kolesar
- Case Western Reserve University, Cleveland Allergy and Asthma Center, Cleveland, Ohio
| | - Jeffrey Hammel
- Case Western Reserve University, Cleveland Allergy and Asthma Center, Cleveland, Ohio
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Chan R, Lipworth B. Real-life effects of dupilumab on airway oscillometry in severe uncontrolled asthma. Ann Allergy Asthma Immunol 2023; 131:664-666. [PMID: 37517659 DOI: 10.1016/j.anai.2023.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Rory Chan
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Dundee, United Kingdom; Ninewells Hospital, Dundee, United Kingdom.
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Dundee, United Kingdom; Ninewells Hospital, Dundee, United Kingdom
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Menzella F, Antonicelli L, Cottini M, Imeri G, Corsi L, Di Marco F. Oscillometry in severe asthma: the state of the art and future perspectives. Expert Rev Respir Med 2023; 17:563-575. [PMID: 37452692 DOI: 10.1080/17476348.2023.2237872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Approximately 3-10% of people with asthma have severe asthma (SA). Patients with SA have greater impairment in daily life and much higher costs. Even if asthma affects the entire bronchial tree, small airways have been recognized as the major site of airflow limitation. There are several tools for studying small airway dysfunction (SAD), but certainly the most interesting is oscillometry. Despite several studies, the clinical usefulness of oscillometry in asthma is still in question. This paper aims to provide evidence supporting the use of oscillometry to improve the management of SA in clinical practice. AREAS COVERED In the ATLANTIS study, SAD was strongly evident across all severity. Various tools are available for evaluation of SAD, and certainly an integrated use of these can provide complete and detailed information. However, the most suitable method is oscillometry, implemented for clinical routine by using either small pressure impulses or small pressure sinusoidal waves. EXPERT OPINION Oscillometry, despite its different technological implementations is the best tool for determining the impact of SAD on asthma and its control. Oscillometry will also be increasingly useful for choosing the appropriate drug, and there is ample room for a more widespread diffusion in clinical practice.
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Affiliation(s)
| | | | | | - Gianluca Imeri
- Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lorenzo Corsi
- Pulmonology Unit, S. Valentino Hospital, Treviso, Italy
| | - Fabiano Di Marco
- Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
- Department of Health Sciences, University of Milan, Bergamo, Italy
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Scioscia G, Tondo P, Nolasco S, Pelaia C, Carpagnano GE, Caiaffa MF, Valenti G, Maglio A, Papia F, Triggiani M, Crimi N, Pelaia G, Vatrella A, Foschino Barbaro MP, Crimi C. Benralizumab in Patients with Severe Eosinophilic Asthma: A Multicentre Real-Life Experience. J Clin Med 2023; 12:4362. [PMID: 37445397 DOI: 10.3390/jcm12134362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Mepolizumab and benralizumab are monoclonal antibodies directed against anti-IL-5 and anti-IL5R, respectively, and their use reduces the exacerbation rate and maintains oral corticosteroid requirements in severe eosinophilic asthma. Previous studies have tested the therapeutic switch between two biologics with excellent results, further demonstrating the heterogeneity of asthmatic disease and the complexity of the therapeutic choice. It remains unclear if such patients may improve following a switch from mepolizumab to benralizumab. AIMS Within a multicentre real-life setting, we decided to evaluate the potential effectiveness of a therapeutic switch to benralizumab in patients with severe eosinophilic asthma initially treated with mepolizumab, who experienced sub-optimal responses. The secondary aim was to identify the clinical factors associated with a better response to benralizumab. METHODS We retrospectively assessed patients with severe eosinophilic asthma treated at six Italian specialist centres, who were switched from mepolizumab to benralizumab following a sub-optimal response, defined as a partial or total lack of clinical remission (i.e., frequent severe exacerbations and/or poorly controlled symptoms and/or higher OCS daily use in patients with a poor or moderate response in the global evaluation of treatment effectiveness scale), after at least 12 months of treatment. RESULTS Twenty-five patients were included in the analysis (mean age 56.76 ± 11.97 years, 65% female). At 6 months of treatment with benralizumab, the ACT score was significantly higher than the ACT score with mepolizumab (20.24 ± 3.38 vs. 16.77 ± 3.48, p < 0.0001); the mean number of daily SABA inhalations was significantly lower after 6 months and 12 months of treatment with benralizumab than that after treatment with mepolizumab; OCS intake and the prednisone median dosage at 6 months of treatment with benralizumab were significantly lower than those with mepolizumab. Benralizumab treatment resulted in a marked improvement in asthma control, suppressed blood eosinophil levels and reduction in the number of exacerbations in the subgroup of patients with severe eosinophilic asthma and nasal polyposis. CONCLUSIONS Patients diagnosed with severe eosinophilic asthma who experience a partial response to mepolizumab could benefit from switching to benralizumab, and even more those who have nasal polyposis.
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Affiliation(s)
- Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Pasquale Tondo
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
| | - Corrado Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Giovanna Elisiana Carpagnano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University "Aldo Moro" of Bari, 70121 Bari, Italy
| | | | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, 90127 Palermo, Italy
| | - Angelantonio Maglio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Francesco Papia
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, 90127 Palermo, Italy
| | - Massimo Triggiani
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | | | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
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10
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Eiwegger T, Bendien SA. Defining the questions to be asked in severe asthma trials: data from the COMSA working group. Eur Respir J 2023; 61:61/4/2202058. [PMID: 37012083 DOI: 10.1183/13993003.02058-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/04/2022] [Indexed: 04/05/2023]
Affiliation(s)
- Thomas Eiwegger
- Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
- Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
- Department of Pediatric and Adolescent Medicine, University Hospital St Pölten, St Pölten, Austria
| | - Sarah A Bendien
- Department of Respiratory Medicine, Haga Teaching Hospital, The Hague, The Netherlands
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11
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Pompe E, Kwee AK, Tejwani V, Siddharthan T, Mohamed Hoesein FA. Imaging-derived biomarkers in Asthma: Current status and future perspectives. Respir Med 2023; 208:107130. [PMID: 36702169 DOI: 10.1016/j.rmed.2023.107130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 01/24/2023]
Abstract
Asthma is a common disorder affecting around 315 million individuals worldwide. The heterogeneity of asthma is becoming increasingly important in the era of personalized treatment and response assessment. Several radiological imaging modalities are available in asthma including chest x-ray, computed tomography (CT) and magnetic resonance imaging (MRI) scanning. In addition to qualitative imaging, quantitative imaging could play an important role in asthma imaging to identify phenotypes with distinct disease course and response to therapy, including biologics. MRI in asthma is mainly performed in research settings given cost, technical challenges, and there is a need for standardization. Imaging analysis applications of artificial intelligence (AI) to subclassify asthma using image analysis have demonstrated initial feasibility, though additional work is necessary to inform the role of AI in clinical practice.
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Affiliation(s)
- Esther Pompe
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Anastasia Kal Kwee
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | | | - Trishul Siddharthan
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami (TS), USA.
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Affiliation(s)
- Peter V Dicpinigaitis
- Albert Einstein College of Medicine and Montefiore Medical Center/Einstein Division, 1825 Eastchester Road, Bronx, NY, 10461, USA.
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Zhou X, Zhang P, Tan H, Dong B, Jing Z, Wu H, Luo J, Zhang Y, Zhang J, Sun X. Progress in diagnosis and treatment of difficult-to-treat asthma in children. Ther Adv Respir Dis 2023; 17:17534666231213637. [PMID: 38069568 PMCID: PMC10710755 DOI: 10.1177/17534666231213637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
At present, medications containing inhaled corticosteroids (ICS-containing) are the keystones of asthma treatment. The majority of asthmatic children can significantly improve clinical outcomes with little worsening by standardized inhaled glucocorticoid treatment, but there is still a small proportion of children who are unable to achieve good symptom control even after the maximum standardized treatment, known as 'children with difficult-to-treat asthma (DA)'. The high heterogeneity of DA makes therapy challenging and expensive, which poses a serious risk to children's health and makes it extremely difficult for clinical physicians to accurately identify and treat children with DA. This article reviews the definition, evaluation, and treatment of this asthma in order to provide a reference for optimal clinical decision-making.
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Affiliation(s)
- Xuehua Zhou
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Panpan Zhang
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Hong Tan
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Bo Dong
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Zenghui Jing
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Huajie Wu
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Jianfeng Luo
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Yao Zhang
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Juan Zhang
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, No. 127, Changle West Road, Xi’an, Shaanxi 710032, China
| | - Xin Sun
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, No. 127, Changle West Road, Xi’an, Shaanxi 710032, China
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