Eosinophilic and Noneosinophilic Asthma

Heaney, Liam G.; Llano, Luís Pérez de; Al‐Ahmad, Mona; Backer, Vibeke; Busby, John; Canonica, Giorgio Walter; Christoff, George; Cosío, Borja G.; FitzGerald, J. Mark; Heffler, Enrico; Iwanaga, Takashi; Jackson, David J.; Menzies‐Gow, Andrew; Papadopoulos, Nikolaos G.; Papaioannou, Andriana Ι.; Pfeffer, Paul; Popov, Todor A.; Porsbjerg, Celeste; Rhee, Chin Kook; Sadatsafavi, Mohsen; Tohda, Yuji; Wang, Eileen; Wechsler, Michael E.; Alacqua, Marianna; Altraja, Alan; Bjermer, Leif; Björnsdóttir, Unnur Steina; Bourdin, Arnaud; Brusselle, Guy; Buhl, Roland; Costello, Richard W.; Hew, Mark; Koh, Mariko Siyue; Lehmann, Sverre; Lehtimäki, Lauri; Peters, Matthew J.; Taillé, Camille; Taube, Christian; Tran, Trung; Zangrilli, James; Bulathsinhala, Lakmini; Carter, Victoria A.; Chaudhry, Isha; Eleangovan, Neva; Hosseini, Naeimeh; Kerkhof, Marjan; Murray, Ruth; Price, Chris; Price, David

doi:10.1016/j.chest.2021.04.013

Cited by 164 publications

(79 citation statements)

References 41 publications

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“…Most severe asthma cohorts show female predominance. 21,[23][24][25] While ISAR confirmed that, it showed proportionately greater prevalence of male sex in the eosinophilic than in the non-eosinophilic group. 21 The eosinophil group were both older and had older age of asthma onset echoing recent identification in the WATCH study of a hitherto less acknowledged adult-onset eosinophilic male difficult asthma phenotype.…”

Section: The Present-day T2 Paradigm Of Inflammation In Asthmamentioning

confidence: 56%

“…21,[23][24][25] While ISAR confirmed that, it showed proportionately greater prevalence of male sex in the eosinophilic than in the non-eosinophilic group. 21 The eosinophil group were both older and had older age of asthma onset echoing recent identification in the WATCH study of a hitherto less acknowledged adult-onset eosinophilic male difficult asthma phenotype. 23 The ISAR study found no significant difference in numerous asthma characteristics including severity between eosinophilic and non-eosinophilic phenotypes.…”

Section: The Present-day T2 Paradigm Of Inflammation In Asthmamentioning

confidence: 56%

“…Heaney et al recently reported findings within ISAR, the International Severe Asthma Registry 21 using data on 1716 patients from 11 national registries. They applied a consensus-driven eosinophil gradient algorithm to assess eosinophilic phenotypes in severe asthma classifying eosinophilic status from Grade 3 (most likely eosinophilic), Grade 2 (likely eosinophilic), Grade 1 (least likely eosinophilic) to Grade 0 (non-eosinophilic).…”

Section: The Present-day T2 Paradigm Of Inflammation In Asthmamentioning

confidence: 99%

“…23 The ISAR study found no significant difference in numerous asthma characteristics including severity between eosinophilic and non-eosinophilic phenotypes. 21 Collectively, these real-world studies suggest exercising caution before designating non-eosinophilic severe asthma status. Eosinophil-phenotype predominance in severe asthma highlights that most severe asthma patients fall within the remit of T2-biologics such as Omalizumab, Mepolizumab, Reslizumab, Benralizumab and Dupilumab which are transforming treatment options for many patients with asthma.…”

Section: The Present-day T2 Paradigm Of Inflammation In Asthmamentioning

confidence: 99%

“…As described above, recently, the ISAR proposed an algorithm to predict an eosinophilic phenotype based on BEC and FeNO combined with select clinical characteristic highlighting the benefit of combining clinically available biomarkers. 21…”

Section: Combining Biomarkersmentioning

confidence: 99%

See 4 more Smart Citations

Recent Insights into the Management of Inflammation in Asthma

Rupani¹,

Fong²,

Kyyaly³

et al. 2021

JIR

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The present prevailing inflammatory paradigm in asthma is of T2-high inflammation orchestrated by key inflammatory cells like Type 2 helper lymphocytes, innate lymphoid cells group 2 and associated cytokines. Eosinophils are key components of this T2 inflammatory pathway and have become key therapeutic targets. Real-world evidence on the predominant T2-high nature of severe asthma is emerging. Various inflammatory biomarkers have been adopted in clinical practice to aid asthma characterization including airway measures such as bronchoscopic biopsy and lavage, induced sputum analysis, and fractional exhaled nitric oxide. Blood measures like eosinophil counts have also gained widespread usage and multicomponent algorithms combining different parameters are now appearing. There is also growing interest in potential future biomarkers including exhaled volatile organic compounds, micro RNAs and urinary biomarkers. Additionally, there is a growing realisation that asthma is a heterogeneous state with numerous phenotypes and associated treatable traits. These may show particular inflammatory patterns and merit-specific management approaches that could improve asthma patient outcomes. Inhaled corticosteroids (ICS) remain the mainstay of asthma management but their use earlier in the course of disease is being advocated. Recent evidence suggests potential roles for ICS in combination with long-acting beta-agonists (LABA) for as needed use in mild asthma whilst maintenance and reliever therapy regimes have gained widespread acceptance. Other anti-inflammatory strategies including ultra-fine particle ICS, leukotriene receptor antagonists and macrolide antibiotics may show efficacy in particular phenotypes too. Monoclonal antibody biologic therapies have recently entered clinical practice with significant impacts on asthma outcomes. Understanding of the efficacy and use of those agents is becoming clearer with a growing body of real-world evidence as is their potential applicability to other treatable comorbid traits. In conclusion, the evolving understanding of T2 driven inflammation alongside a treatable traits disease model is enhancing therapeutic approaches to address inflammation in asthma.

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Section: The Present-day T2 Paradigm Of Inflammation In Asthmamentioning

confidence: 56%

Section: The Present-day T2 Paradigm Of Inflammation In Asthmamentioning

confidence: 56%

Section: The Present-day T2 Paradigm Of Inflammation In Asthmamentioning

confidence: 99%

Section: The Present-day T2 Paradigm Of Inflammation In Asthmamentioning

confidence: 99%

Section: Combining Biomarkersmentioning

confidence: 99%

See 3 more Smart Citations

Recent Insights into the Management of Inflammation in Asthma

Rupani¹,

Fong²,

Kyyaly³

et al. 2021

JIR

View full text Add to dashboard Cite

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How reliably can algorithms identify eosinophilic asthma phenotypes using non‐invasive biomarkers?

Betancor

Olaguibel

Rodrigo‐Muñoz

et al. 2022

Clinical & Translational All

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Background and Aims Asthma is a heterogeneous respiratory disease that encompasses different inflammatory and functional endophenotypes. Many non‐invasive biomarkers has been investigated to its pathobiology. Heany et al proposed a clinical algorithm that classifies severe asthmatic patients into likely‐eosinophilic phenotypes, based on accessible biomarkers: PBE, current treatment, FeNO, presence of nasal polyps (NP) and age of onset. Materials and Methods We assessed the concordance between the algorithm proposed by Heany et al. with sputum examination, the gold standard, in 145 asthmatic patients of the MEGA cohort with varying grades of severity. Results No correlation was found between both classifications 0.025 (CI = 0.013–0.037). Moreover, no relationship was found between sputum eosinophilia and peripheral blood eosinophilia count in the total studied population. Discussion and Conclusion In conclusion, our results suggest that grouping the biomarkers proposed by Heany et al. are insufficient to diagnose eosinophilic phenotypes in asthmatic patients. Sputum analysis remains the gold standard to assess airway inflammation.

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Inflammatory related plasma proteins involved in acute preschool wheeze

Holmdahl,

Chakraborty,

Hoyer

et al. 2023

Clinical & Translational All

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BackgroundPreschool wheeze is a risk factor for asthma development. However, the molecular mechanism behind a wheezing episode is not well understood.ObjectiveOur aims were to assess the association of plasma proteins with acute preschool wheeze and to study the proteins with differential expression at the acute phase at revisit after 3 months. Additionally, to investigate the relationship between protein expression and clinical parameters.MethodWe measured 92 inflammatory proteins in plasma and clinical parameters from 145 children during an episode of preschool wheeze (PW) and at the revisit after 3 months (PW‐R, n = 113/145) and 101 healthy controls (HC) aged 6–48 months in the GEWAC cohort using the antibody‐mediated proximity extension‐based assay (Olink Proteomics, Uppsala).ResultsOf the 74 analysed proteins, 52 were differentially expressed between PW and HC. The expression profiles of the top 10 proteins, Oncostatin M (OSM), IL‐10, IL‐6, Fibroblast growth factor 21 (FGF21), AXIN1, CXCL10, SIRT2, TNFSF11, Tumour necrosis factor β (TNF‐β) and CASP8, could almost entirely separate PW from HC. Five out of 10 proteins were associated with intake of oral corticosteroids (OCS) 24 h preceding blood sampling (OSM, CASP8, IL‐10, TNF‐β and CXCL10). No differences in protein expression were seen between PWs with or without OCS in comparison to HC. At the revisit after 3 months, differential protein expressions were still seen between PW‐R and HC for three (IL‐10, SIRT2 and FGF21) of the 10 proteins.ConclusionOur results contribute to unravelling potential immunopathological pathways shared between preschool wheeze and asthma.

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Eosinophilic and Noneosinophilic Asthma

Cited by 164 publications

References 41 publications

Recent Insights into the Management of Inflammation in Asthma

Recent Insights into the Management of Inflammation in Asthma

How reliably can algorithms identify eosinophilic asthma phenotypes using non‐invasive biomarkers?

Inflammatory related plasma proteins involved in acute preschool wheeze

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