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Donohue PA, Kaminsky DA. The role of oscillometry in asthma. Curr Opin Pulm Med 2024; 30:268-275. [PMID: 38411171 DOI: 10.1097/mcp.0000000000001057] [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: 02/28/2024]
Abstract
PURPOSE OF REVIEW Oscillometry is a noninvasive pulmonary function test that has gained significant interest in the evaluation of lung disease. Currently, oscillometry is primarily a research tool, but there is a growing body of evidence supporting its clinical use. This review describes the recent work evaluating the role of oscillometry in the diagnosis and treatment of asthma. RECENT FINDINGS A large body of observational data supports the ability of oscillometry to distinguish healthy individuals from those with respiratory symptoms or lung disease. Oscillometry may not be as useful as an isolated diagnostic test in asthma, but the combination with other pulmonary function tests may improve its diagnostic ability. Oscillometry can detect peripheral airways dysfunction in asthma, which is associated with symptoms and the risk for exacerbations. To help guide future research, minimal clinically important differences for specific oscillometry variables have been developed. Oscillometry may be useful in monitoring the response to biological therapy and has potential for personalizing treatment for individual patients. Oscillometry also has potential in uncovering unique aspects of the pathophysiology of asthma in obesity. SUMMARY Oscillometry is a promising tool in the diagnosis and management of asthma. More research is needed to support its routine clinical use.
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Affiliation(s)
- Patrick A Donohue
- Division of Pulmonary and Critical Care Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - David A Kaminsky
- Division of Pulmonary and Critical Care, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
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Quarato CMI, Tondo P, Lacedonia D, Soccio P, Fuso P, Sabato E, Hoxhallari A, Foschino Barbaro MP, Scioscia G. Clinical Remission in Patients Affected by Severe Eosinophilic Asthma on Dupilumab Therapy: A Long-Term Real-Life Study. J Clin Med 2024; 13:291. [PMID: 38202298 PMCID: PMC10780210 DOI: 10.3390/jcm13010291] [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: 12/04/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024] Open
Abstract
Background. Nowadays, highly selective biological drugs offer the possibility of treating severe type 2 asthma. However, in the real-life setting, it is crucial to confirm the validity of the chosen biological treatment by evaluating the achievement of clinical remission. Study purpose. The main aims of this real-life study were to evaluate the efficacy of dupilumab in terms of clinical, functional, and inflammatory outcomes at 6, 12, 18, and 24 months of treatment and to estimate the percentage of patients achieving partial or complete clinical remission at 12 and 24 months of treatment. In addition, we attempted to identify whether baseline clinical characteristics of patients could be associated with clinical remission at 24 months of treatment. Materials and methods. In this observational prospective study, 20 outpatients with severe uncontrolled eosinophilic asthma were prescribed dupilumab and followed-up after 6, 12, 18, and 24 months of treatment. At each patient visit, the need for oral corticosteroids (OCS) and corticosteroid required dose, number of exacerbations during the previous year or from the previous visit, asthma control test (ACT) score, pre-bronchodilator forced expiratory volume in the 1st second (FEV1), fractional exhaled nitric oxide at a flow rate of 50 mL/s (FeNO50), and blood eosinophil count were assessed. Results. The number of OCS-dependent patients was reduced from 10 (50%) at baseline to 5 (25%) at one year (T12) and 2 years (T24). The average dose of OCS required by patients demonstrated a significant reduction at T12 (12.5 ± 13.75 mg vs. 2.63 ± 3.94 mg, p = 0.015), remaining significant even at T24 (12.5 ± 13.75 mg vs. 2.63 ± 3.94 mg, p = 0.016). The number of exacerbators showed a statistically significant decrease at T24 (10 patients, 50% vs. 3 patients, 15%, p = 0.03). The mean number of exacerbations demonstrated a statistically significant reduction at T24 (1.45 ± 1.58 vs. 0.25 ± 0.43, p = 0.02). The ACT score improved in a statistically significant manner at T12 (15.30 ± 4.16 vs. 21.40 ± 2.35, p < 0.0001), improving further at T24 (15.30 ± 4.16 vs. 22.10 ± 2.59, p < 0.0001). The improvement in pre-bronchodilator FEV1 values reached statistical significance at T24 (79.5 ± 14.4 vs. 87.7 ± 13.8, p = 0.03). The reduction in flow at the level of the small airways (FEF25-75%) also demonstrated an improvement, although it did not reach statistical significance either at T12 or T24. A total of 11 patients (55%) showed clinical remission at T12 (6 complete + 5 partial) and 12 patients (60%) reached clinical remission at T24 (9 complete + 3 partial). Only obesity was associated with a negative odds ratio (OR) for achieving clinical remission at T24 (OR: 0.03, 95% CI: 0.002-0.41, p = 0.004). No other statistically significant differences in baseline characteristics emerged between patients who reached clinical remission at T24 and the group of patients who did not achieve this outcome. Conclusion. Dupilumab appears to be an effective drug in promoting achievement of clinical remission in patients with severe uncontrolled eosinophilic asthma. The achievement of clinical remission should be continuously evaluated during treatment. Further studies are needed to clarify whether certain baseline clinical characteristics can help predict dupilumab favorable outcomes.
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Affiliation(s)
- Carla Maria Irene Quarato
- Institute of Respiratory Diseases, Policlinico Universitario “Riuniti” di Foggia, 71122 Foggia, Italy; (C.M.I.Q.); (M.P.F.B.)
| | - Pasquale Tondo
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (P.T.); (P.S.)
| | - Donato Lacedonia
- Institute of Respiratory Diseases, Policlinico Universitario “Riuniti” di Foggia, 71122 Foggia, Italy; (C.M.I.Q.); (M.P.F.B.)
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (P.T.); (P.S.)
| | - Piera Soccio
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (P.T.); (P.S.)
| | - Paolo Fuso
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (P.T.); (P.S.)
- Respiratory Diseases Unit, “A. Perrino” P.O di Brindisi, 72100 Brindisi, Italy
| | - Eugenio Sabato
- Respiratory Diseases Unit, “A. Perrino” P.O di Brindisi, 72100 Brindisi, Italy
| | - Anela Hoxhallari
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (P.T.); (P.S.)
| | - Maria Pia Foschino Barbaro
- Institute of Respiratory Diseases, Policlinico Universitario “Riuniti” di Foggia, 71122 Foggia, Italy; (C.M.I.Q.); (M.P.F.B.)
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (P.T.); (P.S.)
| | - Giulia Scioscia
- Institute of Respiratory Diseases, Policlinico Universitario “Riuniti” di Foggia, 71122 Foggia, Italy; (C.M.I.Q.); (M.P.F.B.)
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (P.T.); (P.S.)
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