Limits...
Biomarkers and severe asthma: a critical appraisal.

Chiappori A, De Ferrari L, Folli C, Mauri P, Riccio AM, Canonica GW - Clin Mol Allergy (2015)

Bottom Line: Severe asthma (SA) is a clinically and etiologically heterogeneous respiratory disease which affects among 5-10 % of asthmatic patients.Despite high-dose therapy, a large patients percentage is not fully controlled and has a poor quality of life.We finally underline the need to define different biomarkers panels to select patients affected by severe asthma for specific and personalized therapeutic approach.

View Article: PubMed Central - PubMed

Affiliation: DIMI-Department of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genoa, IRCCS AOU S.Martino-IST, Genoa, Italy.

ABSTRACT
Severe asthma (SA) is a clinically and etiologically heterogeneous respiratory disease which affects among 5-10 % of asthmatic patients. Despite high-dose therapy, a large patients percentage is not fully controlled and has a poor quality of life. In this review, we describe the biomarkers actually known in scientific literature and used in clinical practice for SA assessment and management: neutrophils, eosinophils, periostin, fractional exhaled nitric oxide, exhaled breath condensate and galectins. Moreover, we give an overview on clinical and biological features characterizing severe asthma, paying special attention to the potential use of these ones as reliable markers. We finally underline the need to define different biomarkers panels to select patients affected by severe asthma for specific and personalized therapeutic approach.

No MeSH data available.


Related in: MedlinePlus

Changes in exhaled breath condensate mediators values in severe asthma.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4590266&req=5

Fig1: Changes in exhaled breath condensate mediators values in severe asthma.

Mentions: Exhaled breath (EB) is mainly composed by aerosolized, non-volatile particles of airway lining fluid collected from the airways by airflow turbulence, water vapor condensation, inorganic (O2, N2), and organic (CO2) atmospheric volatile water-soluble gases, endogenous and exogenous volatile organic compounds [67]. EBC is the EB that has been condensed, typically by using a commercially available refrigerating device, according to ATS/ERS Guidelines [68]. It is used to investigate the composition of airway fluids and to achieve information about pulmonary alveoli, inflammation, nitrosative and oxidative stress in airways diseases such as COPD [69], asthma [70] and lung cancer [67]. Concerning SA, clinical studies identified chemical and biological characteristics that distinguish EBC of severe asthmatics from those obtained from healthy subjects and mild to moderate asthmatic patients (Fig. 1). Experimental data on EBC pH in SA are contrasting and there are still few studies about it [71, 72]. Eicosanoids as pro-inflammatory Leukotriene B4 (LTB4) and anti-inflammatory Lipoxin A4 (LXA4) are increased in asthmatics versus healthy subjects and LXA4/LTB4 ratio dramatically decreases in EBC in correlation with asthma severity [73]. Eotaxin-1 was evaluated in blood, EBC, sputum and BALF and was proposed as a tool for assessment of asthma severity [51]. High levels of nitrogen reactive species (NO, NO2−, NO3−) and endogenous ROS (superoxide, hydrogen peroxide, hydroxyl radical) provided evidence for pathologic oxidizing processes in asthma and are indicative of airways oxidative and nitrosative stress [74]. In SA, these pathologic features are exacerbated and correlated to asthma stability and corticosteroid therapy response [75]. Many studies have been published on the use of omics techniques in asthmatic children for the analysis of easy to be collected samples. Using liquid chromatography and mass spectrometry, significant differences useful to distinguish asthma severity between healthy and asthmatic children biochemical profiles were found in urine and in EBC [76–78]. Baraldi et al. proposed the use of metabolomic analysis or breathomic approach of EBC to characterize asthma phenotypes and personalize the therapeutic plan [79]. Fitzpatrick et al. found that SA children showed metabolic differences associated with oxidative stress-related pathways which may contribute to their corticosteroids refractory state [80]. General recommendations for EBC collection and exhaled biomarkers measurements are available in order to avoid a possible alteration in biomarker concentrations. Despite EBC collection remains a procedure potentially influenced by numerous endogenous and exogenous factors, in present and in future, EBC analysis can turn out as a promising, safe and non-invasive method for monitoring SA patients [68].Fig. 1


Biomarkers and severe asthma: a critical appraisal.

Chiappori A, De Ferrari L, Folli C, Mauri P, Riccio AM, Canonica GW - Clin Mol Allergy (2015)

Changes in exhaled breath condensate mediators values in severe asthma.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4590266&req=5

Fig1: Changes in exhaled breath condensate mediators values in severe asthma.
Mentions: Exhaled breath (EB) is mainly composed by aerosolized, non-volatile particles of airway lining fluid collected from the airways by airflow turbulence, water vapor condensation, inorganic (O2, N2), and organic (CO2) atmospheric volatile water-soluble gases, endogenous and exogenous volatile organic compounds [67]. EBC is the EB that has been condensed, typically by using a commercially available refrigerating device, according to ATS/ERS Guidelines [68]. It is used to investigate the composition of airway fluids and to achieve information about pulmonary alveoli, inflammation, nitrosative and oxidative stress in airways diseases such as COPD [69], asthma [70] and lung cancer [67]. Concerning SA, clinical studies identified chemical and biological characteristics that distinguish EBC of severe asthmatics from those obtained from healthy subjects and mild to moderate asthmatic patients (Fig. 1). Experimental data on EBC pH in SA are contrasting and there are still few studies about it [71, 72]. Eicosanoids as pro-inflammatory Leukotriene B4 (LTB4) and anti-inflammatory Lipoxin A4 (LXA4) are increased in asthmatics versus healthy subjects and LXA4/LTB4 ratio dramatically decreases in EBC in correlation with asthma severity [73]. Eotaxin-1 was evaluated in blood, EBC, sputum and BALF and was proposed as a tool for assessment of asthma severity [51]. High levels of nitrogen reactive species (NO, NO2−, NO3−) and endogenous ROS (superoxide, hydrogen peroxide, hydroxyl radical) provided evidence for pathologic oxidizing processes in asthma and are indicative of airways oxidative and nitrosative stress [74]. In SA, these pathologic features are exacerbated and correlated to asthma stability and corticosteroid therapy response [75]. Many studies have been published on the use of omics techniques in asthmatic children for the analysis of easy to be collected samples. Using liquid chromatography and mass spectrometry, significant differences useful to distinguish asthma severity between healthy and asthmatic children biochemical profiles were found in urine and in EBC [76–78]. Baraldi et al. proposed the use of metabolomic analysis or breathomic approach of EBC to characterize asthma phenotypes and personalize the therapeutic plan [79]. Fitzpatrick et al. found that SA children showed metabolic differences associated with oxidative stress-related pathways which may contribute to their corticosteroids refractory state [80]. General recommendations for EBC collection and exhaled biomarkers measurements are available in order to avoid a possible alteration in biomarker concentrations. Despite EBC collection remains a procedure potentially influenced by numerous endogenous and exogenous factors, in present and in future, EBC analysis can turn out as a promising, safe and non-invasive method for monitoring SA patients [68].Fig. 1

Bottom Line: Severe asthma (SA) is a clinically and etiologically heterogeneous respiratory disease which affects among 5-10 % of asthmatic patients.Despite high-dose therapy, a large patients percentage is not fully controlled and has a poor quality of life.We finally underline the need to define different biomarkers panels to select patients affected by severe asthma for specific and personalized therapeutic approach.

View Article: PubMed Central - PubMed

Affiliation: DIMI-Department of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genoa, IRCCS AOU S.Martino-IST, Genoa, Italy.

ABSTRACT
Severe asthma (SA) is a clinically and etiologically heterogeneous respiratory disease which affects among 5-10 % of asthmatic patients. Despite high-dose therapy, a large patients percentage is not fully controlled and has a poor quality of life. In this review, we describe the biomarkers actually known in scientific literature and used in clinical practice for SA assessment and management: neutrophils, eosinophils, periostin, fractional exhaled nitric oxide, exhaled breath condensate and galectins. Moreover, we give an overview on clinical and biological features characterizing severe asthma, paying special attention to the potential use of these ones as reliable markers. We finally underline the need to define different biomarkers panels to select patients affected by severe asthma for specific and personalized therapeutic approach.

No MeSH data available.


Related in: MedlinePlus