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SÖZENER Z, ÖZTÜRK B, AYDIN Ö, MUNGAN D, BAVBEK S. [The profile of severe asthmatics: Results from a specialized asthma clinic]. Tuberk Toraks 2023; 71:156-165. [PMID: 37345398 PMCID: PMC10795275 DOI: 10.5578/tt.20239919] [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: 03/06/2023] [Accepted: 04/21/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction In patients with severe asthma, individualized treatment, and appropriate phenotyping are required to achieve control. In our study, our aim was to examine the characteristics of a specific patient group in a specialized tertiary asthma outpatient clinic, which is the primary setting for evaluating severe asthma patients, with the intention of obtaining national data. Materials and Methods In this cross-sectional observational study, sociodemographic, clinical presentations, laboratory results, and spirometry measurements of patients with severe asthma who were followed up in our specialized asthma outpatient clinic for at least one year were recorded. Patients were defined as eosinophilic if they had a blood eosinophil count of 300/µL or higher at least twice during the oral corticosteroid free-period or 150/µL or higher under oral corticosteroids as allergic if they had sensitization to at least one inhalant allergen consistent with their history. Result Overall, 201 severe asthma patients (74.1% female) with a median disease duration of 15 (min-max= 1-49) years and a median follow-up duration of 7 (min-max= 1-40) years were analyzed. Most of the patients (56.7%) had adult-onset asthma [median age of onset was 32 (min-max= 10-62) years]. Overweight and obese patients were in the majority (31.8%, and 41.8%, respectively) and the median body mass index was 29 (min-max= 17.5-49.5). More than half of the patients (55.2%) had controlled asthma and the median Asthma Control Test score at the last visit was 23. Biologic therapies were applied to 73.1% (n= 147) of the patients [60.5% (n= 89) omalizumab, 39.5% (n= 58) mepolizumab]. Half of the group was allergic (49.3%) and three-quarters of them were eosinophilic (72.1%). Allergic patients had earlier asthma onset and had more controlled disease than nonallergic ones. Eosinophilic patients were younger and less obese than noneosinophilic patients. Obese and late-onset asthmatics had more uncontrolled disease than normal weight subjects and early onset patients. Conclusions The high rate of disease control in the patients with severe asthma in the current study demonstrated the importance of targeted individualized therapy with accurate phenotyping in specialized asthma outpatient clinics.
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Affiliation(s)
- Z.Ç. SÖZENER
- Division of Immunology and Allergic Diseases, Department of Chest Diseases,
Ankara University Faculty of Medicine, Ankara, Türkiye
| | - B.Ö. ÖZTÜRK
- Division of Immunology and Allergic Diseases, Department of Chest Diseases,
Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Ö. AYDIN
- Division of Immunology and Allergic Diseases, Department of Chest Diseases,
Ankara University Faculty of Medicine, Ankara, Türkiye
| | - D. MUNGAN
- Division of Immunology and Allergic Diseases, Department of Chest Diseases,
Ankara University Faculty of Medicine, Ankara, Türkiye
| | - S. BAVBEK
- Division of Immunology and Allergic Diseases, Department of Chest Diseases,
Ankara University Faculty of Medicine, Ankara, Türkiye
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Günaydın F, Ediger D, Erbay M, Pekbak G. Can omalizumab be an alternative treatment for non-atopic severe asthma? A real-life experience with omalizumab. Tuberk Toraks 2023; 71:24-33. [PMID: 36912406 PMCID: PMC10795235 DOI: 10.5578/tt.20239904] [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: 11/18/2022] [Accepted: 01/28/2023] [Indexed: 03/14/2023] Open
Abstract
Introduction Omalizumab, a humanized monoclonal anti-IgE antibody, has largely demonstrated its efficacy in severe allergic asthma. There are limited data about the effectiveness of omalizumab in patients with non-atopic severe persistent asthma. In this study, we aimed to determine the effect of omalizumab in patients with non-atopic severe asthma and compare the data obtained with those in patients with allergic severe asthma. Materials and Methods This study was an observational, retrospective, tertiary single-center study that assessed and compared the clinical outcome of adult patients with severe asthma (165 atopic and 41 non-atopic) who have been on omalizumab for one year or longer between January 2008 and January 2020. Effectiveness was assessed by considering symptom scores (GINA symptom control score), daily systemic corticosteroids (SCS) dosage, blood eosinophil counts, pulmonary function, and number of severe exacerbations and hospitalizations within the last one year. Result Omalizumab exhibited significant improvement in the clinical status of non-atopic asthma patients as measured by GINA symptom score [decreased from 3.77 ± 0.63 to 1.36 ± 1.27 (p<0.001)], the number of emergency room visits for asthma [decreased from 11.25 ± 14.69 to 0.25 ± 0.55 (p<0.001)], and the number of hospitalizations [decreased from 1.17 ± 2.87 to 0.14 ± 0.36 (p= 0.036)]. These results were not significantly different from those obtained in allergic asthma patients. FEV1 improved significantly from 2.08 ± 0.86 to 2.14 ± 0.84 (p= 0.041) and oral corticosteroid doses decreased significantly from 1.67 ± 7.49 to 0.46 ± 2.74 (p= 0.015) in the only atopic group. Conclusions Omalizumab, which is a proven and effective treatment option for allergic asthma, may also be an efficacious alternative option in non-atopic severe asthma.
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Affiliation(s)
- F.E. Günaydın
- Department of Allergy and Immunology, Bursa Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - D. Ediger
- Department of Allergy and Immunology, Bursa Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - M. Erbay
- Department of Allergy and Immunology, Bursa Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - G. Pekbak
- Department of Allergy and Immunology, Bursa Uludağ University Faculty of Medicine, Bursa, Türkiye
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The Role of IgE in Upper and Lower Airway Disease: More Than Just Allergy! Clin Rev Allergy Immunol 2021; 62:200-215. [PMID: 34536215 PMCID: PMC8818003 DOI: 10.1007/s12016-021-08901-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 12/25/2022]
Abstract
Immunoglobulin E (IgE) is a well-known key factor in allergic airway disease; however, its central role in non-allergic airway inflammation is often underestimated. In some airway diseases, IgE is produced as a result of allergic sensitization. However, in others, IgE production occurs despite the lack of a specific allergen. Although multiple pathways contribute to the production of IgE in airway disease, it is its activity in mediating the inflammatory response that is associated with disease. Therefore, an understanding of IgE as the unifying component of upper and lower airway diseases has important implications for both diagnosis and treatment. Understanding the role of IgE in each upper and lower airway disease highlights its potential utility as a diagnostic marker and therapeutic target. Further classification of these diseases by whether they are IgE mediated or non–IgE mediated, rather than by the existence of an underlying allergic component, accounts for both systemic and localized IgE activity. Improvements in diagnostic methodologies and standardization of clinical practices with this classification in mind can help identify patients with IgE-mediated diseases. In doing so, this group of patients can receive optimal care through targeted anti-IgE therapeutics, which have already demonstrated efficacy across numerous IgE-mediated upper and lower airway diseases.
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Campo P, Soto Campos G, Moreira A, Quirce S, Padilla‐Galo A, Martínez‐Moragón E, Mardones A, Dávila I. Real-life study in non-atopic severe asthma patients achieving disease control by omalizumab treatment. Allergy 2021; 76:1868-1872. [PMID: 33220106 DOI: 10.1111/all.14668] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 01/11/2023]
Affiliation(s)
- Paloma Campo
- Allergy Unit IBIMA‐Regional University Hospital of Málaga ARADyAL, Málaga Spain
| | | | | | - Santiago Quirce
- Department of Allergy La Paz Hospital Institute for Health Research (IdiPAZ), Centro de investigación en red de enfermedades respiratorias (CIBERES) Madrid Spain
| | | | | | - Aizea Mardones
- Pneumology Service University Hospital Basurto Bilbao Spain
| | - Ignacio Dávila
- Allergy Service University Hospital of Salamanca and Institute for Biomedical Research of Salamanca (IBSAL), Biomedical and Diagnosis Science Department, Salamanca University School of Medicine Salamanca Spain
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Li B, Huang M, Huang S, Zeng X, Yuan Y, Peng X, Zhao W, Ye Y, Yu C, Liu L, Ou C, Cai S, Zhao H. Prediction of clinical response to omalizumab in moderate-to-severe asthma patients using the change in total serum IgE level. J Thorac Dis 2020; 12:7097-7105. [PMID: 33447398 PMCID: PMC7797858 DOI: 10.21037/jtd-20-2073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Omalizumab (OMA) is an effective anti-immunoglobulin E (IgE) treatment for moderate-to-severe asthma. However, predicting an individual’s response is difficult. Monitoring change of total serum IgE may be useful for predicting the response to OMA. The purpose of this study was to determine if measuring the change in total IgE level could predict the response to OMA in patients with moderate-to-severe asthma. Methods This study included 25 patients (11 females and 14 males; mean age =46.1 years; mean pre-bronchodilator FEV1% =67.8%) with moderate-to-severe asthma. All patients were treated with OMA, and total IgE serum concentrations were measured at baseline before treatment (median baseline total serum IgE =210 IU/mL) and at 4 weeks after beginning treatment. Patients were divided into responders (i.e., excellent or good response) and non-responders (i.e., moderate or poor response) using the global treatment effectiveness (GETE) response method after 16 weeks of treatment. The characteristics of responders and non-responders were compared, and receiver operating characteristic (ROC) curve analysis was used to determine the ability of change in IgE level to predict treatment response. Results There were 20 responders (80%) and 5 non-responders (20%), and responders demonstrated better improvements of asthma control test (ACT) and asthma control questionnaire (ACQ) scores, and reduction of oral corticosteroid use as compared with non-responders. Twenty-one patients had a total serum IgE 4-week-to-baseline ratio ≥2, and 20 of the patients responded to OMA. The area under the ROC curve (AUC) for baseline IgE level for predicting treatment response was 0.53 (95% CI: 0.18–0.88), and that of the week 4 IgE level was 0.69 (95% CI: 0.42–0.96). Using a cutoff value of 2, the 4-week: baseline IgE ratio achieved the highest AUC of 0.87 (95% CI: 0.64–1), with a sensitivity and specificity of 100% and 80%, respectively, for predicting treatment response. Conclusions A total week 4 serum IgE level:baseline level ratio ≥2 can predict the response to OMA in patients with moderate-to-severe asthma after 16 weeks of treatment with high likelihood. Monitoring changes of total IgE level in asthma patients treated OMA may be useful for predicting clinical response.
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Affiliation(s)
- Bohou Li
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Minyu Huang
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shuyu Huang
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoli Zeng
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yafei Yuan
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xianru Peng
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenqu Zhao
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanmei Ye
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Changhui Yu
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Laiyu Liu
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chunquan Ou
- Department of the Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Shaoxi Cai
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Haijin Zhao
- Chronic Airways Diseases Laboratory, Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Erdogan T. Evaluating nonadherence to preventer inhaler therapy in severe asthmatic patients receiving omalizumab. CLINICAL RESPIRATORY JOURNAL 2020; 14:1153-1158. [PMID: 32780932 DOI: 10.1111/crj.13252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/05/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Asthma is one of the most common chronic diseases worldwide and can often be controlled by existing treatments, but in the 5%-10% of patients with severe asthma, control is frequently more challenging. The aim of this paper is to evaluate the adherence to preventer inhaler therapy in severe asthmatic patients receiving omalizumab, a recombinant humanized monoclonal anti-IgE antibody indicated for moderate-to-severe asthma. METHODS This study included 29 patients who were receiving omalizumab treatment as maintenance therapy. All patients completed the six question Turkish Modified Morisky Scale. In addition, patients were classified by adherence to their prescribed preventer therapy, based on pharmaceutical and medical device institution records from the preceding one year. RESULTS Of the 29 enrolled patients, 24.1% had NSAID-exacerbated respiratory disease; 75.9% were female and median age was 47.2 ± 12.99 years. Severe asthma patients demonstrated high levels of motivation (98.8%, n = 28) and knowledge (86.2%, n = 22) about asthma treatment. Nevertheless, the rate of nonadherence to preventer inhaler therapy was only 34.5% (n = 10). There were no significant differences among the characteristics of the patients that might affect the adherence to inhaler therapy. CONCLUSION In patients with severe asthma, suboptimal adherence to preventer inhaler therapy is common before and after omalizumab treatment. Although patients have high levels of motivation and knowledge about asthma treatment, adherence to inhaler preventer therapy declined after omalizumab therapy. Given these findings, it is important to decide whether preventer inhaler therapy should be continued as monotherapy or be discontinued inpatients exhibiting impaired adherence to biological agents, such as omalizumab.
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Affiliation(s)
- Tuba Erdogan
- Faculty of Medicine, Department of Chest Disease, Division of Immunology and Allergy, Osmangazi University, Eskişehir, Turkey
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Cataldo D, Louis R, Michils A, Peché R, Pilette C, Schleich F, Ninane V, Hanon S. Severe asthma: oral corticosteroid alternatives and the need for optimal referral pathways. J Asthma 2020; 58:448-458. [PMID: 31928102 DOI: 10.1080/02770903.2019.1705335] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Patients with severe asthma require high-dose inhaled corticosteroids, with or without add-on treatments, to maintain asthma control. Because symptom control remains unsatisfactory in some patients despite these therapies, maintenance therapy with oral corticosteroids (OCS) remains considered a treatment option by physicians. Besides physician-diagnosed exacerbations, many patients intermittently self-medicate with OCS during episodes of worsening symptoms or as a prevention of such episodes. However, long-term OCS use is associated with several comorbidities that may decrease health-related quality of life, worsen prognosis, and should ideally require monitoring and management. In this review, we discuss the adverse effects of OCS use, the OCS-sparing effect of biologics in severe asthma, and the need for optimal referral pathways to ensure the best outcomes for those at-risk asthma patients. DATA SOURCES PubMed. STUDY SELECTION Studies with results on the OCS-sparing effect of biologics in adult severe asthma were selected. RESULTS Chronic and intermittent OCS use in asthma is associated with considerable adverse effects in asthma. Omalizumab, mepolizumab, benralizumab, and dupilumab reduce the need for OCS in severe asthma, while also reducing the exacerbation rate and improving several patient-related outcomes. CONCLUSION Targeted biologic therapies have revolutionized the treatment of uncontrolled severe asthma by reducing or even eliminating the need for OCS and improving other major outcomes. Novel agents are now rapidly increasing the therapeutic armamentarium, but additional efforts are needed to optimize referral pathways in order to ensure sustainable access to these therapies.
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Affiliation(s)
- Didier Cataldo
- Department of Respiratory Diseases, CHU Liège, GIGA-Research, University of Liège, Liège, Belgium
| | - Renaud Louis
- Department of Respiratory Diseases, CHU Liège, GIGA-Research, University of Liège, Liège, Belgium
| | - Alain Michils
- Chest Department, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Rudi Peché
- Department of Respiratory Medicine, University Hospital Vésale, Montigny-le-Tilleul, Belgium
| | - Charles Pilette
- Department of Pulmonary Medicine, Cliniques Universitaires St Luc, and Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Florence Schleich
- Department of Respiratory Diseases, CHU Liège, GIGA-Research, University of Liège, Liège, Belgium
| | - Vincent Ninane
- Department of Respiratory Medicine, University Hospital Saint-Pierre, Université Libre de Bruxelles, Belgium
| | - Shane Hanon
- Respiratory Division, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Dreher M, Müller T. Add-on Therapy for Symptomatic Asthma despite Long-Acting Beta-Agonists/Inhaled Corticosteroid. Tuberc Respir Dis (Seoul) 2017; 81:1-5. [PMID: 29256220 PMCID: PMC5771741 DOI: 10.4046/trd.2017.0102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/09/2017] [Accepted: 09/13/2017] [Indexed: 11/24/2022] Open
Abstract
Asthma, remains symptomatic despite ongoing treatment with high doses of inhaled corticosteroids (ICS) in conjunction with long-acting beta-agonists (LABA), is classified as “severe” asthma. In the course of caring for those patients diagnosed with severe asthma, stepping up from ICS/LABA to more aggressive therapeutic measures would be justified, though several aspects have to be checked in advance (including inhaler technique, adherence to therapy, and possible associated comorbidities). That accomplished, it would be advisable to step up care in accordance with the Global Initiative for Asthma (GINA) recommendations. Possible strategies include the addition of a leukotriene receptor antagonist or tiotropium (to the treatment regimen). The latter has been shown to be effective in the management of several subgroups of asthma. Oral corticosteroids have commonly been used for the treatment of patients with severe asthma in the past; however, the use of oral corticosteroids is commonly associated with corticosteroid-related adverse events and comorbidities. Therefore, according to GINA 2017 these patients should be referred to experts who specialize in the treatment of severe asthma to check further therapeutic options including biologics before starting treatment with oral corticosteroids.
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Affiliation(s)
- Michael Dreher
- Division of Pneumology, University Hospital RWTH Aachen, Aachen, Germany.
| | - Tobias Müller
- Division of Pneumology, University Hospital RWTH Aachen, Aachen, Germany
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