I have taken my umbrella, so of course it does not rain: Figure 1

Postma, Dirkje S.; Brusselle, Guy; Bush, Andrew; Holloway, John W.

doi:10.1136/thoraxjnl-2011-200758

Cited by 30 publications

(22 citation statements)

References 17 publications

(18 reference statements)

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“…39 Furthermore, some of the genes we have studied are associated not only with COPD but also with asthma. [40][41][42] We cannot fully exclude that observed associations with lung function in our birth cohort might be ascribed to asthma.…”

Section: Discussionmentioning

confidence: 99%

Transient early wheeze and lung function in early childhood associated with chronic obstructive pulmonary disease genes

Kerkhof

Boezen

Granell

et al. 2014

Journal of Allergy and Clinical Immunology

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Section: Discussionmentioning

confidence: 99%

Transient early wheeze and lung function in early childhood associated with chronic obstructive pulmonary disease genes

Kerkhof

Boezen

Granell

et al. 2014

Journal of Allergy and Clinical Immunology

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“…Elsewhere, 25,26 we have argued in detail that the term 'asthma' is an umbrella of dubious provenance, the components of which should be unpicked in nonstraightforward cases of airway disease; in this context, fixed and variable airflow obstruction, and inflammation and infection (Table 2). So at this stage, the evidence should be reviewed and the gaps plugged to determine what actually is going on in the airways of the child.…”

Section: Not Asthma At All: Wrong Diagnosismentioning

confidence: 99%

Severe asthma in children

2017

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Most children with asthma have their disease easily controlled if low-dose inhaled corticosteroids (ICSs) are regularly and correctly administered. If a child presents with asthma which is apparently resistant to therapy with high-dose ICS and other controllers, then they have problematic severe asthma. However, in light of the UK National Review of Asthma Deaths, definitions of severe asthma based solely on the levels of prescribed treatment are too narrow. A detailed assessment of all such children should be performed. First, the diagnosis of asthma should be confirmed, then co-morbidities assessed. Next, a nurse-led assessment further characterizes the problem, conventionally categorizing the child as either having difficult asthma or severe therapy-resistant asthma. Here, we reassess in particular the interactions between, and management of, these two categories, highlighting that this dichotomous classification may need reconsideration. We use bronchoscopy and an intramuscular steroid injection to determine if the child has steroid-resistant asthma, using a novel, multidomain approach because the adult definition does not apply to around half the children we see. Finally, we highlight some mechanistic data which have emerged from this protocol such as the absence of T-helper 2 (TH2) cytokines even in eosinophilic severe asthma and the potential role of the innate epithelial cytokine IL-33, novel data on lineage negative innate lymphoid cells, which we can measure in induced sputum, and demonstrating that intraepithelial neutrophils are associated with better, not worse asthma outcomes. Severe paediatric asthma is very different from severe asthma in adults, and approaches must not be uncritically extrapolated from adult disease to children.

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“…In the recent BOLD (Burden of Obstructive Lung Disease) initiative [112], the occurrence of post-bronchodilator airflow limitation found during screening of population-based samples has been termed COPD, regardless of potential aetiological factors such as smoking, asthma or childhood respiratory disease. As has been pointed out, such an approach, if adopted clinically, is unlikely to lead to the correct therapeutic decision for many patients [113] but, rather, has led to widespread confusion [114].…”

Section: Copd Phenotypes or How To Predict Which Patients Benefit Fromentioning

confidence: 99%

Inhaled corticosteroids in COPD: the clinical evidence

2014

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In this article, we focus on the scientific evidence from randomised trials supporting treatment with inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD), including treatment with combinations of long-acting β-agonist (LABA) bronchodilators and ICS. Our emphasis is on the methodological strengths and limitations that guide the conclusions that may be drawn.The evidence of benefit of ICS and, therefore, of the LABA/ICS combinations in COPD is limited by major methodological problems. From the data reviewed herein, we conclude that there is no survival benefit independent of the effect of long-acting bronchodilation and no effect on FEV1 decline, and that the possible benefit on reducing severe exacerbations is unclear. Our interpretation of the data is that there are substantial adverse effects from the use of ICS in patients with COPD, most notably severe pneumonia resulting in excess deaths.Currently, the most reliable predictor of response to ICS in COPD is the presence of eosinophilic inflammation in the sputum. There is an urgent need for better markers of benefit and risk that can be tested in randomised trials for use in routine specialist practice. Given the overall safety and effectiveness of long-acting bronchodilators in subjects without an asthma component to their COPD, we believe use of such agents without an associated ICS should be favoured. @ERSpublicationsThe benefits of ICS in COPD are limited. Better tools are needed to identify which patients might benefit.

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I have taken my umbrella, so of course it does not rain: Figure 1

Cited by 30 publications

References 17 publications

Transient early wheeze and lung function in early childhood associated with chronic obstructive pulmonary disease genes

Transient early wheeze and lung function in early childhood associated with chronic obstructive pulmonary disease genes

Severe asthma in children

Inhaled corticosteroids in COPD: the clinical evidence

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