Asthma Phenotyping in Primary Care: Applying the International Severe Asthma Registry Eosinophil Phenotype Algorithm Across All Asthma Severities

Biologics in severe asthma: the role of real-world evidence from registries

“…The predominance of the eosinophilic asthma phenotype was also observed when the ISAR eosinophil gradient algorithm was applied to a primary care cohort in the UK: 72.5% of patients had most likely or likely eosinophilic phenotypes, and 5.6% of patients were non-eosinophilic [84]. Therefore, asthma phenotyping should become part of routine clinical care to enable the delivery of phenotype-targeted treatment to patients across all asthma severities [83,84]. Additional research projects on "what severe asthma looks like" include the PATH project, which differentiates severe asthma phenotypes by age of asthma onset [85], and the EMBER project, which evaluates the demographic and clinical characteristics of severe asthma patients with non-type 2 asthma [86].…”

“…The eosinophilic phenotype was predominant in severe asthma: 83.8% of patients were most likely eosinophilic and 1.6% of patients were non-eosinophilic [83]. The predominance of the eosinophilic asthma phenotype was also observed when the ISAR eosinophil gradient algorithm was applied to a primary care cohort in the UK: 72.5% of patients had most likely or likely eosinophilic phenotypes, and 5.6% of patients were non-eosinophilic [84]. Therefore, asthma phenotyping should become part of routine clinical care to enable the delivery of phenotype-targeted treatment to patients across all asthma severities [83,84].…”

Cigarette Smoking and Asthma

“…146,152,153 In a large UK primary care asthma cohort, of whom over 50% were current and former smokers, a multidimensional eosinophil algorithm classified an eosinophilic phenotype in the majority. 154 Current and former smokers with poorly controlled asthma despite moderate dose ICS-LABA who have persistently raised blood eosinophils should be considered for high dose ICS-LABA and/or biologics. The optimum blood eosinophil count cut-off value for high-dose ICS or biologic treatment is uncertain in smokers with asthma.…”

Cigarette Smoking and Asthma

“…147,153,154 In a large UK primary care asthma cohort, of whom over 50% were current and former smokers, a multidimensional eosinophil algorithm classified an eosinophilic phenotype in the majority. 155 Current and former smokers with poorly controlled asthma despite moderate-dose ICS-LABA who have persistently raised blood eosinophils should be considered for high-dose ICS-LABA and/or biologics. The optimum blood eosinophil count cutoff value for high-dose ICS or biologic treatment is uncertain in smokers with asthma.…”