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Lipworth B, Stewart KE, Kuo CR, Chan R. Considerations of clinical trial design to evaluate intranasal corticosteroids in patients with chronic rhinosinusitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1948. [PMID: 38972701 DOI: 10.1016/j.jaip.2024.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 07/09/2024]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research and Rhinology Mega-Clinic, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom.
| | - Kirsten E Stewart
- Scottish Centre for Respiratory Research and Rhinology Mega-Clinic, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research and Rhinology Mega-Clinic, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom
| | - Rory Chan
- Scottish Centre for Respiratory Research and Rhinology Mega-Clinic, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom
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Portacci A, Dragonieri S, Carpagnano GE. Type-2 severe asthma comorbidities in the era of biologics: time to rethink clinical response? Expert Rev Respir Med 2024; 18:249-253. [PMID: 38845590 DOI: 10.1080/17476348.2024.2365841] [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: 02/21/2024] [Accepted: 06/05/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION The use of monoclonal antibodies in patients with severe asthma has led clinicians to explore new levels of clinical improvement, as testified by the growing interest on clinical remission achievement. In this context, a major role is played by asthma-related comorbidities, which can influence asthma pathophysiology and treatment response. AREAS COVERED In this special report, we highlighted how asthma-related comorbidities could deeply affect monoclonal antibody response as well as clinical remission achievement. As examples, we provided data from clinical trials and real-life experiences involving patients with severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), eosinophilic granulomatosis with polyangiitis (EGPA) or bronchiectasis. EXPERT OPINION Comorbidities associated with severe asthma development should be carefully assessed in everyday clinical practice, even with the help of new diagnostic technologies, artificial intelligence and multidisciplinary teams. Future studies should address the role of comorbidities in remission achievement, describing how these diseases could generate new trajectories of clinical and functional response in patient treated with monoclonal antibodies.
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Affiliation(s)
- Andrea Portacci
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", Bari, Italy
| | - Silvano Dragonieri
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", Bari, Italy
| | - Giovanna Elisiana Carpagnano
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", Bari, Italy
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Lipworth B, Stewart K, RuiWen Kuo C, Chan R. The eosinophil paradox in type 2 high severe eosinophilic unified airways disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:265. [PMID: 38185497 DOI: 10.1016/j.jaip.2023.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom.
| | - Kirsten Stewart
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
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Papacharalampous GX, Constantinidis J, Fotiadis G, Zhang N, Bachert C, Katotomichelakis M. Chronic rhinosinusitis with nasal polyps (CRSwNP) treated with omalizumab, dupilumab, or mepolizumab: A systematic review of the current knowledge towards an attempt to compare agents' efficacy. Int Forum Allergy Rhinol 2024; 14:96-109. [PMID: 37394893 DOI: 10.1002/alr.23234] [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: 03/12/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The heterogeneity of existing studies, along with the fact that there are no published head-to-head trials, are the main reasons for the lack of guidelines regarding the selection of the proper biologic in treatment of chronic rhinosinusitis (CRS) with nasal polyps. The aim of this study is to summarize the current knowledge regarding the efficacy of omalizumab, dupilumab, and mepolizumab in CRS treatment. We also attempt to proceed to an indirect comparison of the agents and try to answer the tricky question: which agent to select and why? METHODS An extensive search in English literature was conducted in PubMed/Medline, Embase, Google Scholar, and Cochrane Database/Library. Eligibility criteria included papers with full text published in English, adult population studies, clearly described intervention protocol, and documented primary and secondary outcomes. RESULTS The studies included numbered 37. All agents provided significant improvement in polyp size, sinuses opacification, severity of symptoms, need for surgery and systemic corticosteroids use. Analysis of available systematic reviews, meta-analyses and indirect treatment comparison studies showed that dupilumab appeared to be the most beneficial agent, in terms of primary and secondary outcomes. However, these results are of relatively low level of evidence due to several methodological limitations. CONCLUSIONS Although the present analysis showed a moderate supremacy of dupilumab, there is still no evidence-based answer to the question "which biologic agent is the most effective in CRS treatment?" Improved statistical methodology, head-to-head trials, and real-life studies could lead to more robust conclusions, establishing the real role of the specific biologic agents.
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Affiliation(s)
| | - Jannis Constantinidis
- 1st Department of Otorhinolaryngology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Fotiadis
- Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nan Zhang
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Münster, Münster, Germany
| | - Claus Bachert
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Münster, Münster, Germany
- First Affiliated Hospital, Sun Yat-Sen University, International Airway Research Center, Guangzhou, China
- Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Michael Katotomichelakis
- Department of Otorhinolaryngology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Misirovs R, Chan R, Stewart K, Lipworth B. Phenotypic associations of medical polypectomy and revision surgery following endoscopic sinus surgery: a retrospective study of a single-centre experience in Scotland. J Laryngol Otol 2023; 137:1277-1284. [PMID: 37212124 PMCID: PMC10627783 DOI: 10.1017/s0022215123000853] [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: 02/11/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Some chronic rhinosinusitis with nasal polyps patients undergo revision surgery at some point following initial functional endoscopic sinus surgery. This review aimed to identify the predictive factors for recurrence of nasal polyps requiring oral corticosteroids or revision surgery in chronic rhinosinusitis with nasal polyps following functional endoscopic sinus surgery. METHOD A retrospective analysis of 221 patients who underwent functional endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps in a tertiary rhinology centre, between January 2015 and December 2018, was undertaken. RESULTS Forty-four (21.6 per cent) patients underwent medical polypectomy, 19 (9 per cent) underwent revision surgery and 51 (24.3 per cent) underwent combined polypectomy during the mean follow-up time of 5.3 years. Patients aged less than 55 years of age, with a history of previous functional endoscopic sinus surgery, peripheral blood eosinophil counts of 300 cells/μl or higher, a Lund-Mackay score of more than 17 and concomitant aspirin-exacerbated respiratory disease had significantly increased odds for medical polypectomy, revision surgery and combined polypectomy. CONCLUSION Knowing these predictive factors, clinicians can better identify patients with an increased likelihood of severe polyp recurrence and therefore arrange closer follow-up to optimise therapy.
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Affiliation(s)
- Rasads Misirovs
- Tayside Rhinology Mega-Clinic and Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, UK
- Department of Doctoral Studies, Riga Stradins University, Riga, Latvia
| | - Rory Chan
- Tayside Rhinology Mega-Clinic and Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, UK
| | - Kirsten Stewart
- Tayside Rhinology Mega-Clinic and Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, UK
| | - Brian Lipworth
- Tayside Rhinology Mega-Clinic and Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, UK
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Brar T, McCabe C, Miglani A, Marino M, Lal D. Tissue Eosinophilia is Superior to an Analysis by Polyp Status for the Chronic Rhinosinusitis Transcriptome: An RNA Study. Laryngoscope 2023; 133:2480-2489. [PMID: 36594502 DOI: 10.1002/lary.30544] [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: 09/01/2022] [Revised: 11/29/2022] [Accepted: 12/11/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE RNA sequencing (transcriptomics) is used to study biological pathways. However, the yield of data depends on comparing well-characterized cohorts. We compared tissue eosinophilia versus nasal polyp (NP) status as the metric to characterize transcriptomic mechanisms at play in eosinophilic and non-eosinophilic chronic rhinosinusitis (CRS) versus controls. METHODS RNA sequencing was conducted on sinonasal tissue samples of CRS and controls. Analyses were conducted based on polyp status [with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP)] as well as tissue eosinophil levels per high power field (eos/hpf)[non-eosinophilic (<10 eos/hpf, neCRS) or eosinophilic (≥10 eos/hpf, eCRS)]. The yield of differentially expressed genes (DEGs) and biological pathways through Ingenuity Pathway Analysis (IPA) were compared. RESULTS CRS tissue differed from controls by 736 statistically significant DEGs. Both NP status and tissue eosinophilia were effective in differentiating CRS from controls and into two distinct subgroups. Statistically significant DEGs identified when comparing CRS by NP status were 60, whereas 110 DEGs were identified using eosinophil cutoff ≥10 and <10 eos/hpf. Additionally, heatmaps showed greater homogeneity within each CRS subgroup when analyzed by tissue eosinophilia versus NP status. On IPA, the IL-17 signaling pathway was significantly different only by tissue eosinophilia status, not NP status, being higher in CRS <10 eos/hpf. CONCLUSION Tissue eosinophilia is superior to an analysis by NP status for the study of CRS transcriptome by RNA sequencing in identifying DEGs. Classification of CRS samples by eosinophil counts agnostic of NP status may offer advantageous insights into CRS pathogenetic mechanisms. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2480-2489, 2023.
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Affiliation(s)
- Tripti Brar
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Chantal McCabe
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, Arizona, USA
| | - Amar Miglani
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Michael Marino
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Devyani Lal
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
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Huang Y, Zhang N, Bachert C. Innovative treatments for severe uncontrolled chronic rhinosinusitis with nasal polyps. Expert Rev Clin Immunol 2023; 19:837-845. [PMID: 37083285 DOI: 10.1080/1744666x.2023.2206120] [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: 02/17/2023] [Accepted: 04/19/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION In recent years, endotypes of chronic rhinosinusitis (CRS) based on the underlying immune mechanisms provided a better understanding of this heterogeneous disease and are frequently applied in diagnosis and treatment. AREAS COVERED In this manuscript, we aim to review novel treatment approaches for this often uncontrolled disease and highlight endotype-driven medical algorithms that could be beneficial in daily clinical practice. EXPERT OPINION With the development of endotyping and the mucosal inflammatory concept, several type 2-targeted biologics and surgical options are nowadays available for treating CRS. However, a better understanding based on clinical trials and real-life experience in daily practice is needed to optimize patient selection, biological drug selection, treatment duration, prediction, and long-term follow-up strategies. Indirect comparison analysis suggested that dupilumab might be the most effective biologic for treating CRS with nasal polyps, but the role and timing of surgery remain unclear. More real-life studies and comparative trials are needed for the optimal integration of biologics into clinical pathways in combination with established treatment approaches such as nasal and oral glucocorticosteroids and adequate surgery to provide long-term perspectives.
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Affiliation(s)
- Yanran Huang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
- Upper Airway Research Laboratory, Ghent University Hospital, Ghent, Belgium
| | - Nan Zhang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
- Upper Airway Research Laboratory, Ghent University Hospital, Ghent, Belgium
| | - Claus Bachert
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
- Upper Airway Research Laboratory, Ghent University Hospital, Ghent, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Muenster, Muenster, Germany
- Division of ENT diseases, Stockholm, Sweden
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Chan R, Stewart K, Misirovs R, Lipworth B. Patient-Reported Outcomes with Benralizumab in Patients with Severe Eosinophilic Asthma and Severe Chronic Rhinosinusitis with Nasal Polyps. SINUSITIS 2023. [DOI: 10.3390/sinusitis7010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) and severe eosinophilic asthma (SEA) are common comorbidities characterised by type 2 inflammation associated with increased expression of interleukin 5. Methods: Eight patients with SEA and severe CRSwNP attended the Scottish Centre for Respiratory Research as part of a clinical trial (EudraCT number 2019-003763-22). Following an initial 4-week run-in period (baseline) when patients took their usual inhaled and intranasal corticosteroid treatment for SEA and CRSwNP, they all received subcutaneous benralizumab 30 mg q4w for 12 weeks. Results: Following 12 weeks of benralizumab, no significant differences were detected in nasal global symptom visual analogue score (VAS), hyposmia VAS, total nasal symptom score, or peak nasal inspiratory flow. In contrast, Asthma Control Questionnaire significantly improved along with near-complete depletion of peripheral blood eosinophils by 99%, while eosinophil-derived neurotoxin fell by 72%. Conclusions: Greater improvements in patient-reported outcomes related to asthma were observed than with CRSwNP in response to benralizumab.
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Matabuena M, Salgado FJ, Nieto-Fontarigo JJ, Álvarez-Puebla MJ, Arismendi E, Barranco P, Bobolea I, Caballero ML, Cañas JA, Cárdaba B, Cruz MJ, Curto E, Domínguez-Ortega J, Luna JA, Martínez-Rivera C, Mullol J, Muñoz X, Rodriguez-Garcia J, Olaguibel JM, Picado C, Plaza V, Quirce S, Rial MJ, Romero-Mesones C, Sastre B, Soto-Retes L, Valero A, Valverde-Monge M, Del Pozo V, Sastre J, González-Barcala FJ. Identification of Asthma Phenotypes in the Spanish MEGA Cohort Study Using Cluster Analysis. Arch Bronconeumol 2023; 59:223-231. [PMID: 36732158 DOI: 10.1016/j.arbres.2023.01.007] [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: 11/11/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The definition of asthma phenotypes has not been fully established, neither there are cluster studies showing homogeneous results to solidly establish clear phenotypes. The purpose of this study was to develop a classification algorithm based on unsupervised cluster analysis, identifying clusters that represent clinically relevant asthma phenotypes that may share asthma-related outcomes. METHODS We performed a multicentre prospective cohort study, including adult patients with asthma (N=512) from the MEGA study (Mechanisms underlying the Genesis and evolution of Asthma). A standardised clinical history was completed for each patient. Cluster analysis was performed using the kernel k-groups algorithm. RESULTS Four clusters were identified. Cluster 1 (31.5% of subjects) includes adult-onset atopic patients with better lung function, lower BMI, good asthma control, low ICS dose, and few exacerbations. Cluster 2 (23.6%) is made of adolescent-onset atopic asthma patients with normal lung function, but low adherence to treatment (59% well-controlled) and smokers (48%). Cluster 3 (17.1%) includes adult-onset patients, mostly severe non-atopic, with overweight, the worse lung function and asthma control, and receiving combination of treatments. Cluster 4 (26.7%) consists of the elderly-onset patients, mostly female, atopic (64%), with high BMI and normal lung function, prevalence of smokers and comorbidities. CONCLUSION We defined four phenotypes of asthma using unsupervised cluster analysis. These clusters are clinically relevant and differ from each other as regards FEV1, age of onset, age, BMI, atopy, asthma severity, exacerbations, control, social class, smoking and nasal polyps.
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Affiliation(s)
- Marcos Matabuena
- Centro Singular de Investigación en Tecnoloxías Intelixentes (CiTIUS), University of Santiago of Compostela, Santiago de Compostela, Spain
| | - Francisco Javier Salgado
- Department of Biochemistry and Molecular Biology, School of Biology-Biological Research Centre (CIBUS), University of Santiago de Compostela, Santiago de Compostela, Spain; Translational Research in Airway Diseases Group (TRIAD) - Health Research Institute of Santiago de Compostela (IDIS), Spain
| | - Juan José Nieto-Fontarigo
- Department of Biochemistry and Molecular Biology, School of Biology-Biological Research Centre (CIBUS), University of Santiago de Compostela, Santiago de Compostela, Spain; Translational Research in Airway Diseases Group (TRIAD) - Health Research Institute of Santiago de Compostela (IDIS), Spain; Department of Experimental Medical Science, Lund University, Sweden.
| | | | - Ebymar Arismendi
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Pneumology and Allergy Department, Hospital Clínic de Barcelona, Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Pilar Barranco
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Allergy, La Paz University Hospital, IdiPAZ (Research Institute), Madrid, Spain
| | - Irina Bobolea
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Allergy Unit & Severe Asthma Unit, Pneumonology and Allergy Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - María L Caballero
- Department of Allergy, La Paz University Hospital, IdiPAZ (Research Institute), Madrid, Spain
| | - José Antonio Cañas
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Allergology Service, Jiménez Díaz Foundation University Hospital, Madrid, Spain; Department of Immunology, Health Research Institute Jiménez Díaz Foundation, Madrid, Spain
| | - Blanca Cárdaba
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Immunology, Health Research Institute Jiménez Díaz Foundation, Madrid, Spain
| | - María Jesus Cruz
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Cellular Biology, Physiology and Immunology, Autonomous University of Barcelona, Barcelona, Spain; Pneumology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Elena Curto
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Respiratory Medicine, Santa Creu i Sant Pau Hospital, Barcelona, Spain; Sant Pau Biomedical Research Institute, Sant Pau, Barcelona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Javier Domínguez-Ortega
- Department of Allergy, La Paz University Hospital, IdiPAZ (Research Institute), Madrid, Spain
| | - Juan Alberto Luna
- Department of Allergy, La Paz University Hospital, IdiPAZ (Research Institute), Madrid, Spain
| | - Carlos Martínez-Rivera
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Pneumology Service, Germans Trias i Pujol Hospital, Badalona, Barcelona, Spain
| | - Joaquim Mullol
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Ear, Nose and Throat (ENT) Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Xavier Muñoz
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Cellular Biology, Physiology and Immunology, Autonomous University of Barcelona, Barcelona, Spain; Pneumology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Javier Rodriguez-Garcia
- Department of Biochemistry and Molecular Biology, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José María Olaguibel
- Allergology Department, Navarre University Hospital, Pamplona, Navarra, Spain; Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain
| | - César Picado
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Pneumology and Allergy Department, Hospital Clínic de Barcelona, Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Vicente Plaza
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Respiratory Medicine, Santa Creu i Sant Pau Hospital, Barcelona, Spain; Sant Pau Biomedical Research Institute, Sant Pau, Barcelona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Santiago Quirce
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Allergy, La Paz University Hospital, IdiPAZ (Research Institute), Madrid, Spain
| | - Manuel J Rial
- Allergology Department, A Coruña University Hospital, A Coruña, Spain
| | | | - Beatriz Sastre
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Allergology Service, Jiménez Díaz Foundation University Hospital, Madrid, Spain; Department of Immunology, Health Research Institute Jiménez Díaz Foundation, Madrid, Spain
| | - Lorena Soto-Retes
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Respiratory Medicine, Santa Creu i Sant Pau Hospital, Barcelona, Spain; Sant Pau Biomedical Research Institute, Sant Pau, Barcelona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Antonio Valero
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Pneumology and Allergy Department, Hospital Clínic de Barcelona, Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Marcela Valverde-Monge
- Allergology Service, Jiménez Díaz Foundation University Hospital, Madrid, Spain; Department of Immunology, Health Research Institute Jiménez Díaz Foundation, Madrid, Spain
| | - Victoria Del Pozo
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Allergology Service, Jiménez Díaz Foundation University Hospital, Madrid, Spain; Department of Immunology, Health Research Institute Jiménez Díaz Foundation, Madrid, Spain
| | - Joaquín Sastre
- Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Allergology Service, Jiménez Díaz Foundation University Hospital, Madrid, Spain; Department of Immunology, Health Research Institute Jiménez Díaz Foundation, Madrid, Spain
| | - Francisco Javier González-Barcala
- Translational Research in Airway Diseases Group (TRIAD) - Health Research Institute of Santiago de Compostela (IDIS), Spain; Biomedical Research Centre Network - Respiratory Diseases (CIBERES), Madrid, Spain; Department of Respiratory Medicine, University Hospital of Santiago de Compostela, Spain; Department of Medicine, University of Santiago de Compostela, Spain
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Jin P, Zhao Q, Zang Y, Zhang Q, Shen C, Zhang H, Zhang H, Zhi L. A Google Trends analysis revealed global public interest and awareness of nasal polyps. Eur Arch Otorhinolaryngol 2023; 280:2831-2839. [PMID: 36642736 PMCID: PMC9840878 DOI: 10.1007/s00405-022-07814-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/21/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Nasal polyps (NPs) is a common upper airway inflammatory disorder with a huge negative burden on both the quality of life and costs to patients. However, NPs patients remain undiagnosed and untreated in a timely, which may be due to a lack of disease-related awareness. Google Trends (GT) is an online and open tool, which can provide real-world data on health informatics worldwide. OBJECTIVES This study aimed to explore global public interest and awareness in nasal polyps (NPs) by performing a GT analysis. METHODS Data on relative search volume (RSV) for NPs globally were collected by the public website Google Trends from January 2007 to December 2021. Top-related topics, rising-related topics, and regions were extracted for further analysis. Seasonal variation analysis, the latitude difference analysis, and the rising-related topics between the developed countries and the developing countries were analyzed. A P value less than 0.05 was considered statistically significant. RESULTS The average searching strength showed an overall increasing trend, although with slight fluctuation. The public interest of NPs focuses on the symptoms and treatment for NPs and changes with time. For seasonal variation countries, the peak for the RSV occurred in winter and the bottom in summer. A region in higher latitudes may yield more RSV than that in lower latitudes. The rising-related topics in the recent 5 years reflected the significant differences in treatment and public interest of NPs between the developed and developing countries. CONCLUSIONS Google Trends analysis revealed global public interest and awareness of the evolution of trends and related topics in nasal polyps over time. Geographic distribution and seasonal variation may be potential trigger factors for NPs, and the public's interest in treatment especially biologics is rising.
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Affiliation(s)
- Peng Jin
- grid.452704.00000 0004 7475 0672Department of Otolaryngology, The Second Hospital of Shandong University, No. 247, Beiyuan Road, Jinan, 250033 Shandong China
| | - Qiuliang Zhao
- grid.410638.80000 0000 8910 6733Department of Otolaryngology, The Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yiran Zang
- grid.452704.00000 0004 7475 0672Department of Otolaryngology, The Second Hospital of Shandong University, No. 247, Beiyuan Road, Jinan, 250033 Shandong China
| | - Qinqin Zhang
- grid.452704.00000 0004 7475 0672Department of Otolaryngology, The Second Hospital of Shandong University, No. 247, Beiyuan Road, Jinan, 250033 Shandong China
| | - Chaofan Shen
- grid.452704.00000 0004 7475 0672Department of Otolaryngology, The Second Hospital of Shandong University, No. 247, Beiyuan Road, Jinan, 250033 Shandong China
| | - Hongyang Zhang
- grid.452704.00000 0004 7475 0672Department of Otolaryngology, The Second Hospital of Shandong University, No. 247, Beiyuan Road, Jinan, 250033 Shandong China
| | - Hongping Zhang
- grid.452704.00000 0004 7475 0672Department of Otolaryngology, The Second Hospital of Shandong University, No. 247, Beiyuan Road, Jinan, 250033 Shandong China
| | - Lili Zhi
- grid.452422.70000 0004 0604 7301Department of Allergy, Shandong Provincial Qianfoshan Hospital, Shandong Institute of Respiratory Diseases, The First Affiliated Hospital of Shandong First Medical University, No. 16766, Jingshi Road, Jinan, 250013 Shandong China
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Olfaction in nasal polyp patients after Reboot surgery: an endotype-based prospective study. Eur Arch Otorhinolaryngol 2022; 280:2821-2830. [PMID: 36571613 PMCID: PMC9791624 DOI: 10.1007/s00405-022-07813-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/20/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE To report biomarkers present in the olfactory mucosa in chronic rhinosinusitis with nasal polyps (CRSwNP) in comparison with nasal polyps and to nasal mucosal tissues from control patients. To evaluate the kinetics of smell over 6 months in patients who underwent Reboot surgery. METHODS Cohort study from May 2021 to May 2022. We collected samples of olfactory mucosa and nasal polyps from 16 CRSwNP patients and inferior turbinate samples from 20 control subjects. The study was not randomized for surgical and/or medical treatment. Samples were analyzed by Luminex and Unicap 100 to measure biomarkers of inflammation (IL1-β, IL4, IL5, IL6, IL17, CCL3, CCL4, G-CSF, SE-IgE, total IgE and ECP). 12 of the CRSwNP patients underwent Extended Sniffin'tests at timepoints 1-4 days pre-surgery, and 1, 3 and 6 months after Reboot surgery. RESULTS Type-2 markers were significantly elevated in OM and polyp tissue in CRSwNP (n = 16) vs. controls (n = 20), P < 0.05. TDI scores improved already 1 month (P < 0.05) after surgery and remained stable for 6 months. Type-2 inflammation in nasal polyps was associated with decreased sense of smell and taste before surgery, but improved after surgery (P = 0.048). Type-3 inflammation was present in the olfactory mucosa and was associated with a better sense of smell before surgery, but a smaller improvement of smell afterward. CONCLUSIONS Type-2 inflammation is present in the olfactory mucosa in CRSwNP patients and is associated with smell loss. Reboot surgery, aiming to completely remove inflamed sinus mucosa, significantly improves the smell in this group of patients.
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Gallo S, Castelnuovo P, Spirito L, Feduzi M, Seccia V, Visca D, Spanevello A, Statuti E, Latorre M, Montuori C, Rizzi A, Boccabella C, Bonini M, De Corso E. Mepolizumab Improves Outcomes of Chronic Rhinosinusitis with Nasal Polyps in Severe Asthmatic Patients: A Multicentric Real-Life Study. J Pers Med 2022; 12:jpm12081304. [PMID: 36013253 PMCID: PMC9409669 DOI: 10.3390/jpm12081304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: The upcoming introduction of mepolizumab represents a promising treatment for chronic rhinosinusitis with nasal polyps (CRSwNP). The present study aimed to evaluate the effectiveness of mepolizumab on sinonasal outcomes of comorbid CRSwNP and severe asthma in a real-life setting. The primary endpoint was to evaluate changes in the SinoNasal Outcome Test (SNOT)-22 score, Nasal Polyp (NP) score, and blood eosinophil count during a 12-month treatment with mepolizumab. Secondary endpoints were to quantify mepolizumab’s effects on the mentioned parameters, identify clinical variables influencing the degree of response to treatment, and portray responder and nonresponder patients. Methods: A multicentric retrospective no-profit observational study on severe asthmatic patients, treated with mepolizumab, and comorbid CRSwNP was conducted. All patients were followed for at least 12 months. SNOT-22 score, NP score, and blood eosinophil count (and other CRS-specific variables) were collected at baseline and after 12 months. Results: Forty-three patients were included. A statistically significant reduction was observed for SNOT-22 score (mean t0 SNOT-22 54.8 ± 25.9; mean t12 SNOT-22 31.5 ± 21.3, p < 0.0001), NP score (median t0 NPS 3 (IQR 3); median t12 NPS 2 (IQR 4), p < 0.0001), and blood eosinophil count (mean t0 blood eosinophils 804.7 ± 461.5 cell/µL; mean t12 blood eosinophils 107.5 ± 104.6 cell/µL, p < 0.0001) after 12 months of treatment. Twenty patients (47%) gained improvement both in clinical and endoscopic outcome. Mepolizumab responder patients presented a t0 SNOT-22 significantly higher than nonresponders (p = 0.0011). Conclusions: Mepolizumab improved CRSwNP outcomes in a population of severe asthmatic patients. No clinical feature emerged to outline the profile of a “typical” responder patient, except for baseline SNOT-22 score, which seemed to affect the response to treatment. Further studies would be necessary to supplement these preliminary evaluations.
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Affiliation(s)
- Stefania Gallo
- Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, 21100 Varese, Italy
- UPLOAD (Upper and Lower Airways Inflammatory Diseases) Research Center, University of Insubria, 21100 Varese, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, 21100 Varese, Italy
- UPLOAD (Upper and Lower Airways Inflammatory Diseases) Research Center, University of Insubria, 21100 Varese, Italy
| | - Luca Spirito
- Department of Otorhinolaryngology, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, 21100 Varese, Italy
- UPLOAD (Upper and Lower Airways Inflammatory Diseases) Research Center, University of Insubria, 21100 Varese, Italy
- Correspondence:
| | - Marta Feduzi
- UPLOAD (Upper and Lower Airways Inflammatory Diseases) Research Center, University of Insubria, 21100 Varese, Italy
| | - Veronica Seccia
- Otolaryngology Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124 Pisa, Italy
| | - Dina Visca
- UPLOAD (Upper and Lower Airways Inflammatory Diseases) Research Center, University of Insubria, 21100 Varese, Italy
- Division of Pulmunary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, 21049 Tradate, Italy
| | - Antonio Spanevello
- UPLOAD (Upper and Lower Airways Inflammatory Diseases) Research Center, University of Insubria, 21100 Varese, Italy
- Division of Pulmunary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, 21049 Tradate, Italy
| | - Erica Statuti
- Otolaryngology Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124 Pisa, Italy
| | - Manuela Latorre
- Department of Medical Specialties, Pulmonary Unit, Hospital of Massa, 54100 Massa, Italy
| | - Claudio Montuori
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Angela Rizzi
- Unit of Allergology, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Cristina Boccabella
- Department of Internal Medicine and Geriatrics, Catholic University of the Sacred Hearth, 00168 Rome, Italy
- Unit of Pulmonology, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Matteo Bonini
- Department of Internal Medicine and Geriatrics, Catholic University of the Sacred Hearth, 00168 Rome, Italy
- Unit of Pulmonology, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Eugenio De Corso
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Unit of Otorhinolaryngology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy
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Cai S, Xu S, Lou H, Zhang L. Comparison of Different Biologics for Treating Chronic Rhinosinusitis With Nasal Polyps: A Network Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1876-1886.e7. [PMID: 35272073 DOI: 10.1016/j.jaip.2022.02.034] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/13/2022] [Accepted: 02/21/2022] [Indexed: 05/25/2023]
Abstract
BACKGROUND Several promising clinical trials have demonstrated the effects of type 2 biologics compared with placebos in chronic rhinosinusitis with nasal polyps (CRSwNP). However, there are no head-to-head randomized controlled trials (RCTs) between the biologics. OBJECTIVE To compare the efficacy and safety of different biologics used for the treatment of CRSwNP. METHODS We systematically identified RCTs investigating the effects of biologics for CRSwNP. Primary outcomes were nasal polyp score (NPS), nasal congestion severity, and serious adverse events. Secondary outcomes included the 22-item Sino-Nasal Outcome Test (SNOT-22) score, loss of smell severity, the University of Pennsylvania Smell Identification Test score, and the Lund-Mackay computed tomography score. Bucher indirect treatment comparison (ITC) was used to compare the outcome parameters. RESULTS Seven RCTs (Bachert 2017, OSTRO, POLYP 1, POLYP 2, SINUS-24, SINUS-52, and SYNAPSE) involving 1913 patients and 4 biologics (benralizumab, dupilumab, mepolizumab, and omalizumab) were included for ITC. Dupilumab presented better effects in decreasing NPS and nasal congestion severity compared with the other 3 biologics at 24 weeks of the treatment and at the end of follow-up (more than 48 weeks). Benralizumab was the least effective in reducing nasal congestion severity and SNOT-22 score at 24 weeks. No significant differences were observed between the effects of the other biologics. CONCLUSION Our current findings suggest that dupilumab exhibits the best efficacy and safety for the treatment of CRSwNP.
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Affiliation(s)
- Shiru Cai
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China; Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of Allergic Diseases, Beijing Institute of Otorhinolaryngology, Beijing, P.R. China
| | - Shenglong Xu
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China; Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of Allergic Diseases, Beijing Institute of Otorhinolaryngology, Beijing, P.R. China
| | - Hongfei Lou
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China; Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of Allergic Diseases, Beijing Institute of Otorhinolaryngology, Beijing, P.R. China; Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, P.R. China.
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China; Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of Allergic Diseases, Beijing Institute of Otorhinolaryngology, Beijing, P.R. China; Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, P.R. China; Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China.
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Targeting Downstream Type 2 Cytokines or Upstream Epithelial Alarmins for Severe Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1497-1505. [PMID: 35131510 DOI: 10.1016/j.jaip.2022.01.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/18/2022] [Accepted: 01/24/2022] [Indexed: 12/29/2022]
Abstract
Biologics, including omalizumab, mepolizumab, benralizumab, and dupilumab, targeting downstream IgE, cytokines IL-5, and IL-4/13, respectively, have shown promising effects in terms of reduction in annualized asthma exacerbation rates (AER), oral corticosteroid-sparing effects, improvements in forced expiratory volume in 1 second, and improved Asthma Control Questionnaire scores. However, despite these welcome advances, approximately 30% of patients with severe asthma receiving biologics tailored to their specific downstream type 2 biomarkers, including total IgE, peripheral blood eosinophils, and fractional exhaled nitric oxide, do not experience meaningful improvements in their AER. Instead of blocking downstream cytokines, targeting upstream epithelial alarmins, including IL-33, thymic stromal lymphopoietin, and IL-25, has been proposed to tackle the immunologic heterogeneity of asthma. This review article aims to pragmatically summarize the latest key clinical data on antialarmin therapies in severe asthma and put these findings into context with regard to currently available downstream cytokine blockers.
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Lipworth B, Chan R, Misirovs R, Stewart K. Combined medical and surgical therapy for chronic rhinosinusitis with nasal polyposis. THE LANCET. RESPIRATORY MEDICINE 2022; 10:e38. [PMID: 35364036 DOI: 10.1016/s2213-2600(22)00061-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Brian Lipworth
- Rhinology Mega-Clinic, Ninewells Hospital and Medical School, Dundee DD19SY, UK.
| | - Rory Chan
- Rhinology Mega-Clinic, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Rasads Misirovs
- Rhinology Mega-Clinic, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Kirsten Stewart
- Rhinology Mega-Clinic, Ninewells Hospital and Medical School, Dundee DD19SY, UK
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16
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Fevipiprant in CRSwNP and comorbid asthma: Wrong target population or wrong PGD 2 receptor? J Allergy Clin Immunol 2022; 149:1587-1589. [PMID: 35304159 DOI: 10.1016/j.jaci.2022.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 11/23/2022]
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Lipworth B, Chan R, Misirovs R, Stewart K. Mepolizumab response in severe chronic rhinosinusitis with nasal polyps is dissociated from blood eosinophil levels. J Allergy Clin Immunol 2022; 149:1817. [DOI: 10.1016/j.jaci.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/18/2022] [Indexed: 11/24/2022]
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18
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Custovic A, Siddiqui S, Saglani S. Considering biomarkers in asthma disease severity. J Allergy Clin Immunol 2021; 149:480-487. [PMID: 34942235 DOI: 10.1016/j.jaci.2021.11.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
Amongst patients with asthma, reliance on the type/dose of prescribed medication and symptom control does not adequately capture those at risk of adverse outcomes, and we need biomarkers for risk and treatment stratification which are consistently accurate, readily quantifiable and reproducible. The majority of patients with severe asthma, regardless of age, have predominant type-2 (T2) inflammation mediated disease, making airway/blood eosinophils, FeNO, periostin and/or allergic sensitization potentially important biomarkers for severe disease. In both adult and pediatric asthma, there is scope to improve prediction of severe attacks by using a composite T2 biomarkers of blood eosinophils and FeNO. Technological advances in component-resolved diagnostics (CRD) microarray technologies coupled with the development of interpretation software offer a possibility to use CRD as biomarkers of asthma severity amongst sensitized asthmatics. Genetic predisposition and polygenic risk scores of relevant traits (e.g., lung function, host immune responses, biomarkers of exposure from the indoor and outdoor environment, infection and microbial dysbiosis) may also contribute to prediction algorithms. We challenge the idea that asthma can be accurately defined in an individual patient by a discrete and static "endotype" (e.g., T2-high asthma). As we traverse the new era of molecular endotyping in asthma, we need to understand how relevant mechanisms impact patient outcomes, and in parallel develop new tools and approaches to stratify therapies and define individual patient trajectories.
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Affiliation(s)
- Adnan Custovic
- National Heart and Lung Institute, Imperial College London, UK.
| | - Salman Siddiqui
- Department of Respiratory Sciences, University of Leicester and NIHR Respiratory Biomedical Research Unit, Glenfield Hospital, Leicester UK
| | - Sejal Saglani
- National Heart and Lung Institute, Imperial College London, UK
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