The effects of oral corticosteroids on lung function, type-2 biomarkers and patient-reported outcomes in stable asthma: A systematic review and meta-analysis

Busby, John; Khoo, Esther; Pfeffer, Paul; Mansur, Adel; Heaney, Liam G.

doi:10.1016/j.rmed.2020.106156

Cited by 18 publications

(9 citation statements)

References 75 publications

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“…Studies of biologic-naive patients with SEA showed that prednisolone improved asthma symptoms alongside FEV 1 increase and FENO decrease. [20][21][22][23][24][25][26][27] In contrast, the current study of mepolizumab-treated patients demonstrated that asthma symptoms did not improve despite improvement in small-airway obstruction and reduction in FENO. The lack of symptom improvement after prednisolone in patients on mepolizumab is in keeping with a previous study that showed that improvements in breathlessness, wheeze, and cough measured by VAS were less in those on mepolizumab compared with those without mepolizumab.…”

Section: Discussioncontrasting

confidence: 87%

Corticosteroid Responsiveness Following Mepolizumab in Severe Eosinophilic Asthma—A Randomized, Placebo-Controlled Crossover Trial (MAPLE)

Yang¹,

Busby²,

Heaney³

et al. 2022

The Journal of Allergy and Clinical Immunology: In Practice

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Section: Discussioncontrasting

confidence: 87%

Corticosteroid Responsiveness Following Mepolizumab in Severe Eosinophilic Asthma—A Randomized, Placebo-Controlled Crossover Trial (MAPLE)

Yang¹,

Busby²,

Heaney³

et al. 2022

The Journal of Allergy and Clinical Immunology: In Practice

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“…The fact that patients treated in the acute phase with corticosteroids had lower mean FeNO values than those not treated with such agents is another expected result. While we have no information on whether the use of corticosteroids was in accordance with the recommendations available for hospitalised patients with acute COVID-19 [ 30 ] because such treatment was administered in different hospital settings than in our facilities, it is known that treatment with systemic corticosteroids induces a drastic reduction in FeNO values, although in non-asthmatic subjects it is difficult to predict whether they rise again and, if so, after how long [ 31 ]. In any case, a small study found FeNO levels within the normal range during acute symptoms of SARS-CoV-2 infection, with some increase during the recovery phase, independently of disease severity or the patient's history of atopy.…”

Section: Discussionmentioning

confidence: 99%

Can FeNO be a biomarker in the post-COVID-19 patients monitoring?

Maniscalco

Ambrosino

Poto

et al. 2022

Respiratory Medicine

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The nature of the inflammatory and fibrotic processes found in patients with post-COVID-19 syndrome makes it possible to speculate that in such patients fractional exhaled nitric oxide (FeNO) may be a useful biomarker. Consequently, we set out to verify the consistency of this hypothesis. We consecutively enrolled 68 post-COVID patients after being hospitalized for persistent clinical manifestations within 2 months from disease onset and 29 healthy volunteers as control group. None of post-COVID patients had bronchial asthma or were being treated with a corticosteroid. Only 19 out of 68 post-COVID-19 patients reported a FeNO value > 25 ppb. The mean FeNO value in post-COVID-19 patients was 18.55 ppb (95% CI: 15.50 to 21.58), while in healthy subjects it was 17.46 ppb (95% CI: 15.75 to 19.17). The mean difference was not statistically significant (P = 0.053). However, the mean FeNO value of post-COVID-19 patients was higher in men than in women (20.97 ppb; 95% CI: 16.61 to 25.33 vs 14.36 ppb; 95% CI: 11.11 to 17.61) with a difference between the two sexes that was statistically significant (P = 0.016). Mean FeNO was 14.89 ppb (95% CI: 10.90 to 18.89) in patients who had been treated with systemic corticosteroids because of their COVID-19, and 20.80 ppb (95% CI: 16.56 to 25.04) in those who had not taken them, with a difference that was statistically significant (P = 0.043). The data generated in this study suggest that measurement of FeNO is not useful as a biomarker in post-COVID-19 patient. However, this hypothesis needs solid validation with additional specifically designed studies.

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“…33 Lastly, it must be noted that as with other Th2 biomarkers, EOS stability is affected by corticosteroid use and can be suppressed (~76%) for up to 3 months, therefore clinicians should discern whether there was recent corticosteroid use when interpreting EOS levels. 44,45 Fractional Exhaled Nitric Oxide…”

Section: Sputum and Blood Eosinophilsmentioning

confidence: 99%

Phenotyping, Precision Medicine, and Asthma

Mohan

Lugogo

2022

Semin Respir Crit Care Med

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The traditional one-size-fits all approach based on asthma severity is archaic. Asthma is a heterogenous syndrome rather than a single disease entity. Studies evaluating observable characteristics called phenotypes have elucidated this heterogeneity. Asthma clusters demonstrate overlapping features, are generally stable over time and are reproducible. What the identification of clusters may have failed to do, is move the needle of precision medicine meaningfully in asthma. This may be related to the lack of a straightforward and clinically meaningful way to apply what we have learned about asthma clusters. Clusters are based on both clinical factors and biomarkers. The use of biomarkers is slowly gaining popularity, but phenotyping based on biomarkers is generally greatly underutilized even in subspecialty care. Biomarkers are more often used to evaluate type 2 (T2) inflammatory signatures and eosinophils (sputum and blood), fractional exhaled nitric oxide (FeNO) and serum total and specific immunoglobulin (Ig) E reliably characterize the underlying inflammatory pathways. Biomarkers perform variably and clinicians must be familiar with their advantages and disadvantages to accurately apply them in clinical care. In addition, it is increasingly clear that clinical features are critical in understanding not only phenotypic characterization but in predicting response to therapy and future risk of poor outcomes. Strategies for asthma management will need to leverage our knowledge of biomarkers and clinical features to create composite scores and risk prediction tools that are clinically applicable. Despite significant progress, many questions remain, and more work is required to accurately identify non-T2 biomarkers. Adoption of phenotyping and more consistent use of biomarkers is needed, and we should continue to encourage this incorporation into practice.

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The effects of oral corticosteroids on lung function, type-2 biomarkers and patient-reported outcomes in stable asthma: A systematic review and meta-analysis

Abstract: Accepted/In press). The effects of oral corticosteroids on lung function, type-2 biomarkers and patient-reported outcomes in stable asthma: a systematic review and meta-analysis. Respiratory Research.

Cited by 18 publications

References 75 publications

Corticosteroid Responsiveness Following Mepolizumab in Severe Eosinophilic Asthma—A Randomized, Placebo-Controlled Crossover Trial (MAPLE)

Corticosteroid Responsiveness Following Mepolizumab in Severe Eosinophilic Asthma—A Randomized, Placebo-Controlled Crossover Trial (MAPLE)

Can FeNO be a biomarker in the post-COVID-19 patients monitoring?

Phenotyping, Precision Medicine, and Asthma

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