Impact of reslizumab on outcomes of severe asthmatic patients: current perspectives

Effects of biological therapies on patients with Type-2 high asthma and comorbid obesity

Over 20 million adults and 6 million children in the United States (US) have asthma, a chronic respiratory disease characterized by airway inflammation, bronchoconstriction, and mucus hypersecretion. Obesity, another highly prevalent disease in the US, is a major risk factor for asthma and a significant cause of diminished asthma control, increased submucosal eosinophilia, and reduced quality of life. A large subgroup of these patients experiences severe symptoms and recurrent exacerbations despite maximal dosage of standard asthma therapies. In the past two decades, the development of biological therapies has revolutionized the field and advanced our understanding of type 2 inflammatory biomarkers. However, patients with obesity and comorbid asthma are not principally considered in clinical trials of biologics. Large landmark cluster analyses of patients with asthma have consistently identified specific asthma phenotypes that associate with obesity but may be differentiated by age of asthma onset and inflammatory cell profiles in sputum. These patterns suggest that biologic processes driving asthma pathology are heterogenous among patients with obesity. The biological mechanisms driving pathology in patients with asthma and comorbid obesity are not well understood and likely multifactorial. Future research needs to be done to elicit the cellular and metabolic functions in the relationship of obesity and asthma to yield the best treatment options for this multiplex condition. In this review, we explore the key features of type 2 inflammation in asthma and discuss the effectiveness, safety profile, and research gaps regarding the currently approved biological therapies in asthma patients with obesity.

Management of vernal keratoconjunctivitis: Navigating a changing treatment landscape

Vernal keratoconjunctivitis (VKC) is a chronic, progressive, and potentially sight-threatening form of ocular inflammatory disease that primarily affects children and young adults. Prevalence varies by region, ranging from <2 per 10,000 in the United States to as high as 1,100 per 10,000 in parts of Africa. The rarity of VKC in developed countries can make differential diagnosis challenging, and treatment is often delayed until the disease is advanced, and symptoms are significantly impacting patients' quality of life. Although once viewed primarily as an immunoglobulin E-mediated condition, approximately 50% of patients with VKC do not exhibit allergic sensitization. It is now recognized that the immunopathology of VKC involves multiple inflammatory pathways that lead to the signs, symptoms, and conjunctival eosinophilic and fibroproliferative lesions that are a hallmark of the disease. We examine the evolution of our understanding of the immunopathology of VKC, the expanding VKC treatment armamentarium, the clinical implications of emerging treatment approaches, and future directions for VKC research and practice.

Inhaled drug delivery for the targeted treatment of asthma

Asthma is a chronic lung disease affecting millions worldwide. While classically acknowledged to result from allergen-driven type 2 inflammatory responses leading to IgE and cytokine production and the influx of immune cells such as mast cells and eosinophils, the wide range in asthmatic pathobiological subtypes lead to highly variable responses to anti-inflammatory therapies. Thus, there is a need to develop patient-specific therapies capable of addressing the full spectrum of asthmatic lung disease. Moreover, delivery of targeted treatments for asthma directly to the lung may help to maximize therapeutic benefit, but challenges remain in design of effective formulations for the inhaled route. In this review, we discuss the current understanding of asthmatic disease progression as well as genetic and epigenetic disease modifiers associated with asthma severity and exacerbation of disease. We also overview the limitations of clinically available treatments for asthma and discuss pre-clinical models of asthma used to evaluate new therapies. Based on the shortcomings of existing treatments, we highlight recent advances and new approaches to treat asthma via inhalation for monoclonal antibody delivery, mucolytic therapy to target airway mucus hypersecretion and gene therapies to address underlying drivers of disease. Finally, we conclude with discussion on the prospects for an inhaled vaccine to prevent asthma.

Interpretation of Clinical Efficacy of Biologics in Chronic Rhinosinusitis With Nasal Polyps via Understanding the Local and Systemic Pathomechanisms

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous disease treated with medication or surgery. For recalcitrant type 2 CRSwNP, biological agents have been effectively used to improve nasal polyp score, nasal congestion score, daily symptoms related to CRSwNP, and time to systemic corticosteroid use or revision surgery. Although general guidelines for using biologics to treat CRSwNP were proposed by the European Position Paper on Rhinosinusitis and Nasal Polyps in 2020 and various studies have tested their efficacy, there is much more to learn about biologics—specific indication and choice of biologics based on the endotypes, for instance. Understanding the vascular distribution of monoclonal antibodies and the differences in the vascularity of the non-polyp mucosa and nasal polyp tissue will not only aid understanding of each biologic’s clinical effect but also provide insights to establishing a more personalized approach to treating recalcitrant CRSwNP with biologics.

Immunopharmacology in Vernal Keratoconjunctivitis: Current and Future Perspectives

Vernal keratoconjunctivitis (VKC) is a complex and chronic, multifactorial Th2 cell-mediated chronic ocular surface inflammatory condition that typically affects predominantly male children in hot or warm climates. The primary symptom is intense ocular pruritus, often significant enough to affect activities of daily living. Clinical features differ from simple forms of allergic conjunctivitis in that they are more-or-less confined to the superior tarsus and limbus. There is also a risk of corneal involvement, which leads to irreversible vision loss in approximately 6% of patients. Right now, there is no standardized treatment protocol, and many of the currently available options are not effective in severe and recurrent cases. As such, it is imperative to understand this complex allergic immune response in order to identify future therapeutic targets. This review will focus on potential drug targets in VKC, with particular emphasis on immunomodulators and immunobiologic agents.

The effectiveness of telegram-based virtual education versus in-person education on the quality of life in adolescents with moderate-to-severe asthma: A pilot randomized controlled trial

Aim

In recent years, mobile applications have been developed for health education purposes. The aim of this study was to determine whether Telegram-based virtual education versus in-person education can be effective for improving the quality of life in adolescents with moderate-to-severe asthma.

Design

A single-blind randomized trial.

Methods

Participants were 64 adolescents aged 12-19 years and were equally assigned randomly to group A (Telegram-based education) and group B (in-person education) during 22 June 2017-19 February 2018. The educational contents were similar for both groups. The Mini Pediatric Asthma Quality of Life Questionnaire was used prior to intervention and 5 weeks postintervention for both groups of adolescents.

Results

A statistically significant increase was observed in the quality of life in both groups (p < .001). After controlling the quality-of-life scores, there was no statistically significant difference between the groups in terms of the mean score for the quality of life and its domains (p < .05).

Cross-cultural adaptation and validation of the RhinAsthma Patient Perspective (RAPP) in the Polish population

Introduction

The RhinAsthma Patient Perspective (RAPP) was developed in Italian to assess the Health Related Quality of Life (HRQoL) impairment in patients with asthma and allergic rhinitis (AR) in daily practice.

Aim

To cross-culturally validate the Polish version.

Material and methods

The Polish version was administered to patients suffering from asthma and rhinitis in a prospective observational study. Polish RAPP, along with SF-12, ACT, and a Symptomatologic VAS was filled in twice, with a 4-week interval between visits. At visit 2, a Global Rating Scale (GRS) was completed to assess any change in health status. Internal consistency, validity, reliability, discriminant ability and responsiveness to change as well as Minimal Important Difference were determined.

Results

The factor and confirmatory analysis revealed a unidimensional structure of RAPP. Internal consistency was satisfactory with Cronbach’s α (visit 1 = 0.85, visit 2 = 0.89). High reliability (ICC = 0.89 and a CCC = 0.94) was found. Validity analyses showed good correlations of the Polish RAPP with Physical and Mental Component Scores of SF-12. In addition, RAPP adequately discriminated patients on the basis of the asthma control level and rhinitis severity (p < 0.03 for all the analyses), and demonstrated to be sensitive to change. MID value was 1 point.

Conclusions

The study confirmed the reliability and validity of the Polish version of RAPP demonstrating that it is a useful tool in the assessment of HRQoL in patients with asthma and comorbid allergic rhinitis, in clinical practice.