Phenotype-Driven Therapeutics in Severe Asthma

Opina, Maria Theresa D; Moore, Wendy C.

doi:10.1007/s11882-017-0678-1

Cited by 37 publications

(20 citation statements)

References 79 publications

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“…it led to improvement of asthma (symptoms, control, lung function, rescue medication for attacks, and exacerbation), and ENT outcomes (symptoms, CT scan images, number of episodes of acute rhinosinusitis) independently of the presence of AERD. The study population is characteristic of the asthma-CRSNP+ phenotype, with predominant adult-onset asthma, a high prevalence of allergic rhinitis and previous sinonasal surgery, a high exacerbation rate, poorly controlled asthma, airway obstruction, and an eosinophilic inflammatory pattern [7,8,12,22]. The prevalence of AERD in this study was 37.5%, which was higher than previously reported for severe asthma (14.9%) [10].…”

Section: Discussionmentioning

confidence: 57%

“…Inhaled corticosteroids remain the cornerstone of treatment, and current guidelines recommend a step-up approach, with incremental dosing and additonal controller medication in order to achieve symptom control and prevent exacerbations [4][5][6]. While most patients respond well to these guideline-based treatement approaches, 5%-10% remain refractory despite the maximal therapeutic regimen defining the "severe asthma" population [5,7]. The severe allergic asthma (SAA) phenotype is a type of severe asthma in patients with an allergic background and high serum IgE level.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of Omalizumab in Severe Allergic Asthma and Nasal Polyposis: A Real-Life Study

Tiotiu¹,

Oster²,

Roux³

et al. 2020

J Investig Allergol Clin Immunol

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Background: Omalizumab is a human anti-IgE antibody approved for the treatment of severe allergic asthma (SAA). However, its effectiveness in SAA associated with chronic rhinosinusitis with nasal polyposis (CRSNP+) is less well documented. Objective: The aim of this study was to evaluate the real-life effectiveness of omalizumab in patients with SAA and CRSNP+ who tolerated and did not tolerate aspirin. Methods: We performed a retrospective, observational, multicenter, real-life study of patients with SAA and CRSNP+ treated with omalizumab for 6 months. Asthma outcome parameters (symptoms, number of salbutamol rescues/wk, number of moderate/severe exacerbations, Asthma Control Test score, and lung function), sinonasal outcome parameters (symptoms, number of episodes of acute rhinosinusitis, sinus computed tomography images, nasal polyps endoscopy score), and serum eosinophil levels were analyzed 6 months before and after treatment with omalizumab. Results: Twenty-four adult patients were included (9 with documented aspirin intolerance). All respiratory parameters were significantly improved by the treatment. In parallel, a significant improvement was observed in sinonasal clinical outcomes and sinus computed tomography images, with no major effect on the nasal polyps endoscopy score. The serum eosinophil count decreased significantly after 6 months of treatment with omalizumab. Conclusion: Treatment of SAA with omalizumab improves the outcome of associated CRSNP+, thus supporting the concept of a "one airway disease".

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Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Effectiveness of Omalizumab in Severe Allergic Asthma and Nasal Polyposis: A Real-Life Study

Tiotiu¹,

Oster²,

Roux³

et al. 2020

J Investig Allergol Clin Immunol

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“…We instead propose that biomarkers be used to identify patients within a cluster who are most likely to be responders to a given immunomodulator as a disease modifier, not to define a specific clinical phenotype. 43 …”

Section: Biomarkers Associated With Clinical Phenotypesmentioning

confidence: 99%

Severe Asthma Phenotypes — How Should They Guide Evaluation and Treatment?

Fitzpatrick

Moore

2017

The Journal of Allergy and Clinical Immunology: In Practice

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110

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Although patients with “severe” asthma tend to be characterized by ongoing symptoms and airway inflammation despite treatment with high doses of inhaled and systemic corticosteroids, there is increasing recognition of marked phenotypic heterogeneity within affected patients. While “precision medicine” approaches for patients with severe asthma are needed, there are many hurdles that must be overcome in daily practice. The National Heart, Lung and Blood Institute's Severe Asthma Research Program (SARP) has been at the forefront of phenotype discovery in severe asthma for the past decade. SARP, along with other international groups, have described clinical severe asthma phenotypes in both adults and children that can be evaluated in the clinical setting. While these clinical phenotypes provide a good “starting point” for addressing disease heterogeneity in severe asthma in everyday practice, more efforts are needed to understand how these phenotypes relate to underlying disease mechanisms and pharmacological treatment responses. This review highlights the clinical asthma phenotypes identified to date, their associations with underlying endotypes and potential biomarkers, and remaining knowledge gaps that must be addressed before precision medicine can become a reality for patients with severe asthma.

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“…In general, biomarkers, exacerbation history and age of asthma onset were highlighted as the most important factors in the identification of asthma phenotypes. Indeed, the distinction between early and late onset of the disease (childhood versus adulthood) and the incorporation of biomarkers into the phenotyping process have been key in the phenotypic characterisation of asthma [15,20]. In terms of clinical practice, blood eosinophils and FENO were identified as commonly used biomarkers.…”

Section: Identification and Use Of Biomarkers And Phenotypes In Dailymentioning

confidence: 99%

Severe T2-high asthma in the biologics era: European experts' opinion

et al. 2019

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The European Respiratory Biologics Forum gathered participants from 21 countries in Madrid, Spain, to discuss the management and treatment of severe asthma in the era of biologics. The current insights on the pathophysiology of severe asthma were discussed, as well as the role of respiratory biologics in clinical practice and strategies for eliminating chronic use of oral corticosteroids. The participants also highlighted the key challenges in identifying patients with severe asthma based on phenotypes, biomarkers and treatable traits, and the existing problems in patient referral to specialist care. The monitoring of treatment was debated and the need for a change towards precision medicine and personalised care was emphasised throughout the meeting. This review provides a summary of the discussions and highlights important concerns identified by the participants regarding the current management of severe asthma.

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Phenotype-Driven Therapeutics in Severe Asthma

Cited by 37 publications

References 79 publications

Effectiveness of Omalizumab in Severe Allergic Asthma and Nasal Polyposis: A Real-Life Study

Effectiveness of Omalizumab in Severe Allergic Asthma and Nasal Polyposis: A Real-Life Study

Severe Asthma Phenotypes — How Should They Guide Evaluation and Treatment?

Severe T2-high asthma in the biologics era: European experts' opinion

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