Predictors and associations of the persistent airflow limitation phenotype in asthma: a post-hoc analysis of the ATLANTIS study

Kole, Tessa; Berghe, Elise Vanden; Kraft, Monica; Vonk, Judith M.; Nawijn, Martijn C.; Siddiqui, Salman; Sun, Kai; Fabbri, Leonardo; Rabe, Klaus F.; Nicolini, Gabriele; Singh, Dave; Molen, Thys van der; Dahlén, Sven‐Erik; Kerstjens, Huib A. M.; Badorrek, Philipp; Broeders, M.E.A.C.; Boersma, Willem; Chetta, Alfredo; Cukier, Alberto; D’Amato, Mariella; Djukanović, Ratko; Foschino, Maria Pia; Geßner, Christian; Hanania, Nicola A.; Martin, Richard J.; Milleri, Stefano; Olivenstein, Ronald; Paggiaro, Pierluigi; Pizzichini, Emílio; Moral, Vicente Plaza; Postma, Dirkje S.; Scichilone, Nicola; Schilz, Robert; Stelmach, Rafaël; Vroegop, J. Sebastiaan; Usmani, Omar; Zhang, Q.; Ahmed, Hassan; Allen, David J.; Ballereau, S.; Batuwitage, Manohara; Bedding, Alun; Behndig, Annelie F.; Berglind, A.; Berton, Alix; Bigler, Jeanette; Boedigheimer, Michael; Bønnelykke, Klaus; Brinkman, Paul; Bush, Andy; Campagna, Davide; Casaulta, Carmen; Chaiboonchoe, Amphun; Davison, Timothy S.; Meulder, Bertrand De; Delin, Ingrid; Dennison, Paddy; Dodson, P M; Hadjam, L. El; Eržen, Damijan; Faulenbach, Cornelia; Fichtner, K.; Fitch, Neil; Formaggio, Elena; Gahlemann, Martina; Gálffy, Gabriella; Garissi, D.; Garret, T.; Guillmant-Farry, E.; Henriksson, Elisabet Welin; Hoda, Uruj; Hohlfeld, J.M.; Hu, Xinyue; James, Anna; Johnson, Katherine Waltman; Jullian, N.; Kerry, Gina; Klüglich, Matthias; Knowles, Richard G.; Konradsen, Jon R.; Kretsos, Kosmas; Krueger, Linn; Lantz, A-S.; Larminie, Christopher; Latzin, Philipp; Lefaudeux, Diane; Lemonnier, Nathanaël; Lowe, Lesley; Lutter, René; Manta, Alexander; Mazein, Alexander; McEvoy, Leslie M.; Menzies‐Gow, Andrew; Mores, Nadia; Murray, C.S.; Nething, Katja; Nihlén, Ulf; Niven, Robert; Nordlund, Björn; Nsubuga, S.; Pellet, J.; Pison, Christophe; Praticò, G.; Valls, M. Puig; Riemann, Kathrin; Rocha, J.P.; Rossios, Christos; Santini, Giuseppe; Sagi, M.; Scott, Stephen; Sehgal, Neha; Selby, Anna; Söderman, P.; Sogbesan, A.; Spycher, F.; Stephan, S.; Stokholm, Jakob; Sunther, M.; Szentkereszty, M.; Tamási, Lilla; Tariq, Kamran; Valente, Salvatore; Aalderen, W. M. van; Drunen, Cornelis M. van; Eyll, Jonathan van; Vyas, Aashish; Yu, Wai‐Cho; Zetterguist, W.; Zolkipli, Zaraquiza; Zwinderman, A. H.; Agustí, Àlvar; Wedzicha, Jadwiga A.; Donaldson, Gavin; Faner, Rosa; Breyer‐Kohansal, Robab; Zee, Anke H. Maitland‐van der; Melén, Erik; Allinson, James P.; Vanfleteren, Lowie E.G.W.; Vestbo, Jørgen; Adcock, Ian M.; Lahousse, Lies; Berge, Maarten van den; Alter, Peter; Barbé, Ferrán; Brightling, Chris; Breyer, Marie‐Kathrin; Burghuber, Otto Chris; Casas, Maribel; Chung, Kian Fan; Cosío, Borja G.; Crispi, F.; Batlle, J. De; Fitting, Jean-William; García, J.M. Pino; Hallberg, Jenny; Hartl, Sylvia; Jarvis, Deborah; Mathioudakis, Alexander G.; Nicod, Laurent; Papi, Alberto; Ritchie, Andrew I.; Sigsgaard, Torben; Sterk, Peter J.; Ullman, Anders; Vellvé, Kilian; Vogelmeier, Claus; Wheelock, Åsa M.; Wheelock, Craig E.; Spanevello, Antonio

doi:10.1016/s2213-2600(22)00185-0

Cited by 37 publications

(13 citation statements)

References 19 publications

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“…Bei schwerem Asthma korreliert der klinische Schweregrad der Erkrankung oft nicht mit dem Ausmaß der lungenfunktionellen Einschränkung. Auch findet sich, im Gegensatz zu leichteren Asthmaformen, bei der Mehrheit der Patienten mit schwerem Asthma keine Akutreversibilität nach SABA-Inhalation [91,92]. Bei Patienten mit schwerem Asthma spielen daher die genaue Anamnese-Erhebung, der Grad der Asthma-Kontrolle, die Erfassung der Biomarker und die Beurteilung des Therapie-Ansprechens eine besonders wichtige Rolle [86].…”

Section: Schweres Asthmaunclassified

S2k-Leitlinie zur fachärztlichen Diagnostik und Therapie von Asthma 2023

et al. 2023

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ZusammenfassungDas Management von Asthma hat sich in den letzten Jahrzehnten fundamental gewandelt. Die vorliegende Leitlinie zur Diagnostik und Therapie von Asthma wurde für pneumologisch tätige Fachärztinnen und Fachärzte entwickelt, welche detaillierte und evidenzbasierte Informationen zu den neuen diagnostischen und therapeutischen Optionen von Asthma benötigen. Die Leitlinie zeigt die neue Bedeutung der Biomarker, insbesondere der Bluteosinophilen und des exhalierten NO (FeNO), in den diagnostischen Algorithmen von Asthma. Als erste Asthma-Leitlinie weltweit benennt die vorliegende Leitlinie die nachhaltige Symptomprävention und die Asthma-Remission als Asthma-Therapieziele, welche durch den Einsatz individuell angepasster, krankheitsmodifizierender Medikamente (wie inhalative Steroide, Allergenimmuntherapie oder Biologika) erreicht werden können. Die zentrale Bedeutung der Behandlung von typischen Asthma-Komorbiditäten wird zudem betont. Schließlich wird auch auf besondere Herausforderungen im Asthma-Management eingegangen, wie bspw. die Therapie von Asthma in der Schwangerschaft, die Behandlung von schwerem Asthma oder die Diagnostik und Therapie von arbeitsbedingten Asthma-Formen.

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Section: Schweres Asthmaunclassified

S2k-Leitlinie zur fachärztlichen Diagnostik und Therapie von Asthma 2023

et al. 2023

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“…>70%. [17,18] A restrictive ventilatory defect is characterised physiologically by a reduction in TLC as determined by plethysmography or gas distribution assessment (TLC per definition <lower 5th percentile) and can be inferred on spirometry when the FEV 1 /FVC% is normal or high and the FVC is reduced (Fig. 9).…”

Section: Categorisation Of Spirometric Resultsmentioning

confidence: 99%

Position statement for adult and paediatric spirometry in South Africa: 2022 update

Maree

Swanepoel²,

Swart³

et al. 2022

Afr J Thoracic Crit Care Med

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Spirometry is required as part of the comprehensive evaluation of both adult and paediatric individuals with suspected or confirmed respiratory diseases and occupational assessments. It is used in the categorisation of impairment, grading of severity, assessment of potential progression and response to interventions. Guidelines for spirometry in South Africa are required to improve the quality, standardisation and usefulness in local respiratory practice. The broad principles of spirometry have remained largely unchanged from previous versions of the South African Spirometry Guidelines; however, minor adjustments have been incorporated from more comprehensive international guidelines, including adoption of the Global Lung Function Initiative 2012 (GLI 2012) spirometry reference equations for the South African population. All equipment should have proof of validation regarding resolution and consistency of the system. Daily calibration must be performed, and equipment quality control processes adhered to. It is important to have standard operating procedures to ensure consistency and quality and, additionally, strict infection control as highlighted during the COVID-19 pandemic.Adequate spirometry relies on a competent, trained operator, accurate equipment, standardised operating procedures, quality control and patient co-operation. All manoeuvres must be performed strictly according to guidelines, and strict quality assurance methods should be in place, including acceptability criteria (for any given effort) and repeatability (between efforts). Results must be categorised and graded according to current guidelines, taking into consideration the indication for the test.

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“…Of note, this definition does not include a lack of SABA reversibility as a COPD criterion. There is now accumulating evidence that SABA reversibility can be absent in asthma [14,15]. This is most prominent in patients with severe asthma; more than 65% of all patients with severe asthma lack SABA reversibility [14,15].…”

Section: Discussionmentioning

confidence: 99%

“…There is now accumulating evidence that SABA reversibility can be absent in asthma [14,15]. This is most prominent in patients with severe asthma; more than 65% of all patients with severe asthma lack SABA reversibility [14,15]. Furthermore, response to biologics does not depend on SABA reversibility in patients with severe asthma [16,17].…”

Section: Discussionmentioning

confidence: 99%

Response to Various Biologics in Patients with Both Asthma and Chronic Obstructive Pulmonary Disease

Lommatzsch,

Mohme,

Stoll

et al. 2023

Respiration

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Introduction: Patients can have features of both chronic obstructive pulmonary disease (COPD) and asthma. However, there is still no consensus how to precisely define this patient population. In addition, there are little data on the effectiveness of biologics in these patients. Method: Presence of COPD was defined by a smoking history of ≥10 pack years (PY), a postbronchodilator FEV1/FVC ratio < lower limit of normal (LLN) and FEV1 < 80% predicted, a carbon monoxide diffusion capacity (DLCO) < LLN, and dyspnoea on exertion as a leading symptom. Presence of asthma was defined by high type 2 biomarkers (blood eosinophils ≥300 cells/μL and/or FeNO ≥50 ppb), typical clinical features of asthma (including nocturnal respiratory symptoms), and a documented history of a clinical benefit from inhaled and/or oral glucocorticoid treatment. We analysed data from 20 patients fulfilling the criteria for both COPD and asthma who were newly treated with a biologic due to recurrent exacerbations despite high-dose inhaled triple therapy. Results: Median values before treatment with a biologic were as follows: 40 PY, FEV1 42% predicted, DLCO 45% predicted, 475 eosinophils/μL blood, FeNO 48 ppb. Median duration of biologic treatment (mepolizumab, benralizumab, dupilumab, omalizumab, or tezepelumab) was 12 months. There were significant improvements in exacerbations (most prominent effect), asthma control, and lung function during biologic treatment. Conclusions: Various types of biologics approved for severe asthma treatment can be effective in patients with both COPD and asthma. We propose an easy-to-use definition of these patients for routine clinical practice.

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Predictors and associations of the persistent airflow limitation phenotype in asthma: a post-hoc analysis of the ATLANTIS study

Cited by 37 publications

References 19 publications

S2k-Leitlinie zur fachärztlichen Diagnostik und Therapie von Asthma 2023

S2k-Leitlinie zur fachärztlichen Diagnostik und Therapie von Asthma 2023

Position statement for adult and paediatric spirometry in South Africa: 2022 update

Response to Various Biologics in Patients with Both Asthma and Chronic Obstructive Pulmonary Disease

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