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New therapies and management strategies in the treatment of asthma: patient-focused developments.

Agbetile J, Green R - J Asthma Allergy (2010)

Bottom Line: It is increasingly recognized that large proportions of patients with asthma remain poorly controlled with daily symptoms, limitation in activities, or severe exacerbations despite traditional treatment with inhaled corticosteroids and other agents.This suggests that there is considerable scope for the refinement of traditional guidelines on the use of inhaled therapies in asthma and also a need for the development of novel therapeutic agents, particularly for the treatment of severe asthma.Secondly, we will review new strategies to better use the existing therapies such as inhaled corticosteroids and long-acting β(2)-agonists that remain the mainstay of treatment for most patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine and Thoracic Surgery, Institute for Lung Health, Glenfield Hospital, Leicester, UK.

ABSTRACT
It is increasingly recognized that large proportions of patients with asthma remain poorly controlled with daily symptoms, limitation in activities, or severe exacerbations despite traditional treatment with inhaled corticosteroids and other agents. This suggests that there is considerable scope for the refinement of traditional guidelines on the use of inhaled therapies in asthma and also a need for the development of novel therapeutic agents, particularly for the treatment of severe asthma. This review aims to discuss a range of emerging treatment approaches in asthma. Firstly, we will set the scene by highlighting the importance of achieving good asthma control in a patient-focused manner and discussing recent work that has furthered our understanding of asthma phenotypes and paved the way for patient-specific treatments. Secondly, we will review new strategies to better use the existing therapies such as inhaled corticosteroids and long-acting β(2)-agonists that remain the mainstay of treatment for most patients. Finally, we will review the novel therapies that are becoming available, both pharmacological and interventional, and discuss their likely place in the management of this complex disease.

No MeSH data available.


Related in: MedlinePlus

Clinical asthma phenotypes. Copyright © 2010, American Thoracic Society. Reproduced with permission from Haldar P, Pavord ID, Shaw DE, et al. Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med. 2008;178(3):218–224.
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Related In: Results  -  Collection


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f1-jaa-4-001: Clinical asthma phenotypes. Copyright © 2010, American Thoracic Society. Reproduced with permission from Haldar P, Pavord ID, Shaw DE, et al. Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med. 2008;178(3):218–224.

Mentions: We have recently described the results of a study using the technique of cluster analysis within a population of patients with severe asthma treated in our clinic compared with a second population managed in primary care. Cluster analysis is a multivariate statistical tool that seeks to organize information about variables so that heterogeneous groups of subjects can be classified into relatively homogeneous subgroups or ‘clusters’. By including large numbers of variables, this approach may reveal associations that were not previously evident and lead to the identification of distinct novel phenotypes. Our results (Figure 1) identified two clusters (early-onset atopic asthma and obese, noneosinophilic asthma) that were common to both asthma populations. In contrast, two clusters characterized by marked discordance between symptom expression and eosinophilic airway inflammation (early-onset, symptom-predominant asthma and late-onset, inflammation-predominant asthma) were specific to refractory asthma. The identification of these separate phenotypes of asthma and in particular the recognition of the disparity between symptoms and inflammation highlight the need for the development of different management strategies for different groups of patients. A management strategy based on targeting airway inflammation may be particularly helpful for patients with inflammation-predominant asthma,15 for example, and will be discussed later. Further consideration of the complexity of the different aspects of airways disease has led to the recent suggestion that traditional labels applied to airways disease (including asthma and chronic obstructive pulmonary disease [COPD]) be replaced by an A to E alphabetical assessment tool using factors potentially responsible for morbidity: airway hyperresponsiveness, bronchitis, cough reflex hypersensitivity, and damage to the airway and surrounding lung, and extrapulmonary factors.20 This may offer a useful checklist to remind the clinician of the need to relate clinical presentation with underlying pathophysiology, and in doing so to select the most appropriate treatment strategy. For some patients, particularly those with difficult-to-treat asthma, this may be a novel pharmacological agent, whereas, for others, more judicious use of existing treatments may be sufficient to achieve good control.


New therapies and management strategies in the treatment of asthma: patient-focused developments.

Agbetile J, Green R - J Asthma Allergy (2010)

Clinical asthma phenotypes. Copyright © 2010, American Thoracic Society. Reproduced with permission from Haldar P, Pavord ID, Shaw DE, et al. Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med. 2008;178(3):218–224.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3108304&req=5

f1-jaa-4-001: Clinical asthma phenotypes. Copyright © 2010, American Thoracic Society. Reproduced with permission from Haldar P, Pavord ID, Shaw DE, et al. Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med. 2008;178(3):218–224.
Mentions: We have recently described the results of a study using the technique of cluster analysis within a population of patients with severe asthma treated in our clinic compared with a second population managed in primary care. Cluster analysis is a multivariate statistical tool that seeks to organize information about variables so that heterogeneous groups of subjects can be classified into relatively homogeneous subgroups or ‘clusters’. By including large numbers of variables, this approach may reveal associations that were not previously evident and lead to the identification of distinct novel phenotypes. Our results (Figure 1) identified two clusters (early-onset atopic asthma and obese, noneosinophilic asthma) that were common to both asthma populations. In contrast, two clusters characterized by marked discordance between symptom expression and eosinophilic airway inflammation (early-onset, symptom-predominant asthma and late-onset, inflammation-predominant asthma) were specific to refractory asthma. The identification of these separate phenotypes of asthma and in particular the recognition of the disparity between symptoms and inflammation highlight the need for the development of different management strategies for different groups of patients. A management strategy based on targeting airway inflammation may be particularly helpful for patients with inflammation-predominant asthma,15 for example, and will be discussed later. Further consideration of the complexity of the different aspects of airways disease has led to the recent suggestion that traditional labels applied to airways disease (including asthma and chronic obstructive pulmonary disease [COPD]) be replaced by an A to E alphabetical assessment tool using factors potentially responsible for morbidity: airway hyperresponsiveness, bronchitis, cough reflex hypersensitivity, and damage to the airway and surrounding lung, and extrapulmonary factors.20 This may offer a useful checklist to remind the clinician of the need to relate clinical presentation with underlying pathophysiology, and in doing so to select the most appropriate treatment strategy. For some patients, particularly those with difficult-to-treat asthma, this may be a novel pharmacological agent, whereas, for others, more judicious use of existing treatments may be sufficient to achieve good control.

Bottom Line: It is increasingly recognized that large proportions of patients with asthma remain poorly controlled with daily symptoms, limitation in activities, or severe exacerbations despite traditional treatment with inhaled corticosteroids and other agents.This suggests that there is considerable scope for the refinement of traditional guidelines on the use of inhaled therapies in asthma and also a need for the development of novel therapeutic agents, particularly for the treatment of severe asthma.Secondly, we will review new strategies to better use the existing therapies such as inhaled corticosteroids and long-acting β(2)-agonists that remain the mainstay of treatment for most patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine and Thoracic Surgery, Institute for Lung Health, Glenfield Hospital, Leicester, UK.

ABSTRACT
It is increasingly recognized that large proportions of patients with asthma remain poorly controlled with daily symptoms, limitation in activities, or severe exacerbations despite traditional treatment with inhaled corticosteroids and other agents. This suggests that there is considerable scope for the refinement of traditional guidelines on the use of inhaled therapies in asthma and also a need for the development of novel therapeutic agents, particularly for the treatment of severe asthma. This review aims to discuss a range of emerging treatment approaches in asthma. Firstly, we will set the scene by highlighting the importance of achieving good asthma control in a patient-focused manner and discussing recent work that has furthered our understanding of asthma phenotypes and paved the way for patient-specific treatments. Secondly, we will review new strategies to better use the existing therapies such as inhaled corticosteroids and long-acting β(2)-agonists that remain the mainstay of treatment for most patients. Finally, we will review the novel therapies that are becoming available, both pharmacological and interventional, and discuss their likely place in the management of this complex disease.

No MeSH data available.


Related in: MedlinePlus