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

Pavord, Ian; Bahmer, Thomas; Braido, Fulvio; Cosío, Borja G.; Humbert, Marc; Idzko, Marco; Adamek, Lukasz

doi:10.1183/16000617.0054-2019

Cited by 38 publications

(32 citation statements)

References 71 publications

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“…In many patients, a comprehensive approach to treatable traits might be required to achieve control of asthma symptoms. 32 There are several limitations with this analysis, including the ongoing nature of the study. Patients without all baseline forms completed were excluded from this analysis; among those with complete forms, some patients had missing data.…”

Section: Discussionmentioning

confidence: 99%

Biologic and maintenance systemic corticosteroid therapy among US subspecialist-treated patients with severe asthma

Moore

Panettieri

Trevor

et al. 2020

Annals of Allergy, Asthma & Immunology

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Background: Severe asthma (SA) often requires subspecialist management and treatment with biologic therapies or maintenance systemic corticosteroids (mSCS). Objective: To describe contemporary, real-world biologic and mSCS use among US subspecialist-treated patients with SA. Methods: CHRONICLE is an ongoing, noninterventional study of US adults with SA treated by allergists/ immunologists or pulmonologists. Eligible patients are receiving biologics or mSCS or are uncontrolled on high-dosage inhaled corticosteroids with additional controllers. Biologic and mSCS use patterns and patient characteristics were summarized for patients enrolled between February 2018 and February 2019. Results: Among protocol-eligible patients, 58% and 12% were receiving biologics and mSCS, respectively, with 7% receiving both. Among 796 enrolled, most were women (67%), non-Hispanic white (71%), of suburban residence (50%), and had elevated body mass index (median: 31). Respiratory and nonrespiratory comorbidities were highly prevalent. With biologics (n ¼ 557), 51% were antieimmunoglobulin E and 48% were antieinterleukin (IL)-5/IL-5Ra; from May 2018, 76% of initiations were antieIL-5/IL-5Ra. In patients receiving mSCS, median prednisone-equivalent daily dose was 10 mg. Multivariate logistic regression found that patients of hospital clinics, sites with fewer nonphysician staff, and with a recorded concurrent chronic

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Section: Discussionmentioning

confidence: 99%

Biologic and maintenance systemic corticosteroid therapy among US subspecialist-treated patients with severe asthma

Moore

Panettieri

Trevor

et al. 2020

Annals of Allergy, Asthma & Immunology

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“…This survey has shown that Croatian referral centers are capable and correctly equipped for phenotype identification, which is widely accepted as having a major impact on managing SA [21]. Furthermore, the majority of those surveyed expressed confidence in diagnosing SA, although some indicated a need for more experience.…”

Section: Plos Onementioning

confidence: 91%

“…In patients with SA, in addition to non-recognition of asthma mimickers, the main barrier to correct diagnosis is poor recognition and comprehension of the severity of the disorder [21,22]. This lack of appropriate testing and lack of recognition often result in delayed [21,23]. We also identified a lack of appropriate referrals for patients discharged after an acute exacerbation.…”

Section: Plos Onementioning

confidence: 99%

“…According to pulmonologists' experiences, our results indicated that Croatian GPs rarely undertake diagnostic procedures to verify asthma quantitatively. In patients with SA, in addition to non-recognition of asthma mimickers, the main barrier to correct diagnosis is poor recognition and comprehension of the severity of the disorder [21,22]. This lack of appropriate testing and lack of recognition often result in delayed [21,23].…”

Section: Plos Onementioning

confidence: 99%

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Attitudes of Croatian pulmonologists concerning obstacles to earlier, more appropriate use of biologics in severe asthma: Survey results

et al. 2021

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Aims Biologics have been proven efficacious for patients with severe asthma (SA). It is essential to diagnose such individuals correctly. This study was designed to survey pulmonologists to identify barriers to early diagnosis and subsequent appropriate use of biologics for SA in Croatia. Methods A pulmonologist group with expertise in SA developed the initial list of questions, with the final questionnaire created according to a 2-round Delphi method. The resulting survey consisted of 23 items consequently divided into 4 domains: 1) Pulmonologists’ demographics and professional experiences; 2) Concerns about asthma management; 3) Attitudes toward SA diagnosis; and 4) Beliefs and attitudes regarding the use of biologics in managing SA. The given answers represented the respondents’ estimates. Results Eighty-four surveys were analyzed, with pulmonologists observing that general practitioners often inaccurately diagnose asthma and treat acute exacerbations. Although specialist centers are capably and correctly equipped, the time to diagnose patients with SA is approximately 3.5 months, with initial use of biologics delayed an additional 2 months. The primary indications for prescribing biologics are conventional therapy with oral glucocorticoids (91.7%) and frequent acute exacerbations (82.1%). In addition to improper diagnosis (64.3%), many patients with SA do not receive the indicated biologics owing to strict administrative directives for reimbursement (70.2%) or limited hospital resources (57.1%). Limitations The limitations of this survey include the subjective nature of the collected data, the relatively small sample size, and the lack of the biologic efficacy evaluation. Conclusions Croatian pulmonologists observed that a significant number of patients with SA who are eligible for biologics are not prescribed them, largely because of an inaccurate and/or delayed diagnosis, a delayed referral to a specialist center, highly restrictive criteria for reimbursement, and/or institutional budgetary limitations.

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“…70-80% of corticosteroid-naïve and 50% of corticosteroid-treated asthma patients have a raised sputum eosinophil count [1], which is generally associated with enhanced expression of the type-2 cytokines interleukin (IL)-4, IL-5 and IL-13 [2], increased fractional exhaled nitric oxide (FeNO), peripheral blood eosinophilia and a reproducible type-2 inflammatory epithelial gene signature [3]. This 'type-2 high' phenotype is characteristically responsive to treatment with inhaled corticosteroids (ICS), and, in severe disease, to biologic agents targeting these type-2 cytokines [4].…”

Section: Introductionmentioning

confidence: 99%

Treatment options in type-2 low asthma

2020

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Monoclonal antibodies targeting IgE or the type-2 cytokines IL-4, IL-5 and IL-13 are proving highly effective in reducing exacerbations and symptoms in people with severe allergic and eosinophilic asthma respectively. However, these therapies are not appropriate for 30–50% of patients in severe asthma clinics who present with non-allergic, non-eosinophilic, “type-2 low” asthma. These patients constitute an important and common clinical asthma phenotype, driven by distinct, though poorly understood pathobiological mechanisms. In this review we describe the heterogeneity and clinical characteristics of type-2 low asthma and summarise current knowledge on the underlying pathobiological mechanisms, which includes neutrophilic airway inflammation often associated with smoking, obesity, occupational exposures and may be driven by persistent bacterial infections and by activation of a recently-described IL-6 pathway. We review the evidence base underlying existing treatment options for specific treatable traits which can be identified and addressed. We particularly focus on severe asthma as opposed to difficult-to-treat asthma, on emerging data on the identification of airway bacterial infection, on the increasing evidence base for the use of long-term low-dose macrolides, a critical appraisal of bronchial thermoplasty, and evidence for the use of biologics in type-2 low disease. Finally we review ongoing research into other pathways including TNF, IL-17, resolvins, apolipoproteins, type I interferons, IL-6 and mast cells. We suggest that type-2 low disease frequently presents opportunities for identification and treatment of tractable clinical problems and is currently a rapidly evolving field with potential for the development of novel targeted therapeutics.

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

Cited by 38 publications

References 71 publications

Biologic and maintenance systemic corticosteroid therapy among US subspecialist-treated patients with severe asthma

Biologic and maintenance systemic corticosteroid therapy among US subspecialist-treated patients with severe asthma

Attitudes of Croatian pulmonologists concerning obstacles to earlier, more appropriate use of biologics in severe asthma: Survey results

Treatment options in type-2 low asthma

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