The burden of severe asthma in childhood and adolescence: results from the paediatric U-BIOPRED cohorts

Fleming, Louise; Murray, Clare; Bansal, Aruna T.; Hashimoto, Simone; Bisgaard, Hans; Bush, Andrew; Frey, Urs; Hedlin, Gunilla; Singer, Florian; Aalderen, W. M. van; Vissing, Nadja Hawwa; Zolkipli, Zaraquiza; Selby, Anna; Fowler, Stephen J.; Shaw, Dominick; Chung, Kian Fan; Sousa, Ana R.; Wagers, Scott; Corfield, Julie; Pandis, Ioannis; Rowe, Anthony; Formaggio, Elena; Sterk, Peter J.; Roberts, Graham

doi:10.1183/13993003.00780-2015

Cited by 202 publications

(161 citation statements)

References 32 publications

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“…Our results are very similar to those found in the SA group of the recent European U-BIOPRED study [38], where 70% had an ACT score <19. More than half of the children in the UcSA group had an ACT score <14 owing to poorly controlled asthma and a high risk of serious exacerbations [28].…”

Section: Discussionsupporting

confidence: 81%

“…More than half of the children in the UcSA group had an ACT score <14 owing to poorly controlled asthma and a high risk of serious exacerbations [28]. The mean PAQLQ score was 4.3, which was slightly lower than the SA group of the European study (mean 4.7 for school-aged group) [38] and the TENOR study (5.4 in children) [30], suggesting poor quality of life among the patients in our study. Subjective measures of asthma control and quality of life are useful for identifying children with problematic asthma [40].…”

Section: Discussionmentioning

confidence: 51%

“…Levels of total serum IgE, which have been linked to greater asthma severity, have been found to be higher in the UcSA group [36], and most children were sensitized to aeroallergens. According to various studies [37,38], unlike adults [39], children tend to be atopic with high levels of total IgE and FeNO and with peripheral eosinophilia and aeroallergen sensitization.…”

Section: Discussionmentioning

confidence: 99%

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Role of Periostin in Uncontrolled Asthma in Children (DADO study)

Mena

Abejón

Vidigal

et al. 2017

J Investig Allergol Clin Immunol

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Background: Asthma is the most common chronic disease in children. Cases of severe asthma (SA) are underdiagnosed. Periostin is a biomarker for SA in adults, but its role in children is poorly understood. Objectives: The aims of the study were to estimate the percentage of cases of uncontrolled severe asthma (UcSA) in children with poorly controlled asthma and to evaluate the role of periostin as a biomarker. Materials and Methods: We performed an observational study in children aged 5 to 14 years with poorly controlled asthma. Demographic and clinical data were collected in addition to the results of the lung function test, the fraction of exhaled nitric oxide, the skin prick test, total IgE, specific IgE, blood eosinophil count, serum periostin, treatment, asthma control, and quality of life. Variables were compared between the group with UcSA and the other children. Results: Fifty children with poorly controlled asthma (72% male) were included. Nineteen children (38%) had UcSA. Most children had limitations in their activities of daily living and had visited the emergency department. In addition, 38% were hospitalized. Quality of life was poor. Only 42% of the children received appropriate treatment. The UcSA group was more likely to have a total IgE >500 kU A /mL (52.6% vs 19%, P=.02) and less likely to have serum periostin >1000 ng/mL (31.2% vs 63%, P=.04). Conclusions: In our setting, 38% of children with poorly controlled asthma have UcSA, which is associated with higher levels of total serum IgE and lower levels of serum periostin.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

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Role of Periostin in Uncontrolled Asthma in Children (DADO study)

Mena

Abejón

Vidigal

et al. 2017

J Investig Allergol Clin Immunol

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“…The EU-funded Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED) project has just published details of their paediatric and adult severe asthma cohorts 31,32 . This cross-sectional assessment of adults with severe asthma, mild/ moderate asthma, and healthy controls from 11 European countries showed that patients with severe asthma had more symptoms and exacerbations (2.5 exacerbations versus 0.4 in the preceding 12 months) compared to patients with mild/moderate disease, with worse quality of life and higher levels of anxiety and depression.…”

Section: Phenotyping Based On Clustering Of Clinical-physiological Datamentioning

confidence: 99%

Phenotyping Asthma: Linking Clinical Features to Biomolecular Pathways

Chung¹

2016

BRN

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Asthma presents in various clinical forms and levels of severity and has a complex pathophysiology. Unbiased clustering was initially performed on clinical features, but the addition of biomarkers such as sputum and blood cellular profiles has led to the description of several phenotypes and enabled the prediction of responses to targeted therapies. Clusters of severe asthma include those on high-dose corticosteroid treatment, often with both inhaled and oral treatment, associated with severe airflow obstruction. Concordance between symptoms and sputum eosinophilia is observed in an eosinophilic inflammation-predominant group with few symptoms and late-onset disease who have a high prevalence of rhinosinusitis, aspirin sensitivity, and exacerbations. Sputum or blood eosinophilia is also a biomarker that can predict therapeutic responses to antibody-based treatments to block the effects of the T-helper-2 cytokine, interleukin-5. Low T-helper-2 expression predicts poor therapeutic response to inhaled corticosteroid therapy. Much less is known about 'non-eosinophilic' or non-T-helper-2 asthma. Clustering on transcriptomic and/or proteomic data is leading to definition of molecular phenotypes and potential mechanisms. The definition of endotypes and biomarkers of disease and therapeutic responses will pave the way towards personalized medicine and healthcare for asthma. For the clinician, these will translate into useful tools and means for managing patients with asthma, particularly severe asthma. Corresponding author : Kian Fan Chung, f.chung@imperial.ac.uk

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“…A major molecular mechanism of asthma is considered to be driven by type 2 T-helper cells (Th2) and eosinophilic airway inflammation in both atopic and non-atopic asthma [1]. Over recent years, however, extensive research has revealed that Th2-low subtypes are also common, particularly in severe asthma [2][3][4]. These non-Th2 asthma endotype patients may not respond adequately to usual treatment, including glucocorticosteroids and novel targeted biologics such as anti-immunoglobulin E (IgE) and anti-interleukin 5 (IL-5), and there is an urgent need for further research and therapeutic options in this group of asthmatics [5].…”

mentioning

confidence: 99%