Reviews and feature articleAdvances in asthma in 2016: Designing individualized approaches to management
Section snippets
Viral infections in asthmatic patients and the promise of therapeutic targets
Respiratory viruses remain a key trigger of asthma exacerbations, providing insight into the evolution and pathophysiology of asthma. In a prospective observational cohort study involving 183 asthmatic children aged 6 to 17 years, Kantor et al2 found that subjects with rhinovirus infection had more severe exacerbations than those participants with virus-negative exacerbations. In this cohort rhinovirus-triggered asthma exacerbations became more severe as the degree of sensitization to dust mite
Characterization of the airway microbiome
Through detailed assessments of the airway microbiome, key differences between asthmatic patients, nonasthmatic subjects, and those at risk for asthma have been characterized. Regarding at-risk populations, the nasopharyngeal microbiota in more than 1000 infants with bronchiolitis was analyzed as part of a large multicenter study.9 In this prospective cohort infants with bronchiolitis caused by RSV had a high abundance of Firmicutes and the genus Streptococcus and a low abundance of
Novel genetic associations with asthma and the biologic effect of known gene variants
Through discovery of new associations and demonstration of the biologic effects of known gene variations, the link between genetic changes and asthma expanded in 2016 (Table I).13, 14, 15, 16 Doublesex and mab-3–related transcription factor 1 (DMRT1) emerged as a novel candidate to potentially explain sex-specific asthma effects during childhood.13 A single nucleotide polymorphism (SNP) on chromosome 8 was associated with early lung function decrease in 2 asthma cohorts and was also associated
Influence of air quality and climate on asthma
Annesi-Maesano20 provided an overview of allergy-specific health issues emerging because of climate change, as well as future directions regarding climate-related health. Worldwide, only 12% of urban populations breath air that complies with World Health Organization Air Quality Guidelines. Citing NASA data, we learn not only that the earth has experienced a 0.8°C/1.4°F average global temperature increase since the 1880s but also that two thirds of this warming has occurred since 1975.
Exposures during different stages of development and long-term sequelae of childhood asthma
Among the well-described risk factors for asthma, recent research is helping to define the level of influence had by these risk factors. The Inner-City Asthma Consortium conducted a causal network analysis on a conceptual model of 8 potential asthma risk factor domains. They found that the model could explain about 50% of the variance in asthma severity. The 2 biggest drivers of asthma severity were an allergy pathway starting with allergic sensitization and an environmental tobacco smoke
Patient-centered outcomes research reflects patient priorities and engages stakeholders
The National Asthma Education and Prevention Program Expert Panel Report,37 which was last updated in 2007, provides guidance for the management of asthma. For the most part, it is informed by efficacy studies. These narrowly defined studies include patients most likely to benefit and who are treated under the most promising conditions. However, a limitation of these well-controlled studies is that the interventions are not always effective when applied in the real world, do not take into
Clinical risk factors
Wells et al44 add support to this patient-centered approach by demonstrating that neither self-reported race-ethnicity nor race defined by genetic ancestry predicted ICS response; rather, baseline lung function and self-reported asthma control do, emphasizing the need to find ways to ensure optimal lung function, asthma control, and elimination of barriers to accessing care. Szentpetery et al45 describe asthma risk factors among Puerto Ricans, including exposure to environmental tobacco,
Precision medicine
In January 2015, President Obama proposed a Precision Medicine Initiative52 considering each patient's uniqueness and the need for tailoring treatment to take into account individual variability in genes, environment, and lifestyle. This initiative aligns with translational and comparative effectiveness research, seeking to understand environmental, clinical, and lifestyle risk factors that characterize phenotypes and identifying the biomarkers to help define the pathophysiologic mechanisms or
Application of biomarkers to personalized medicine
In 2012, the JACI published a report from the National Institutes of Health (NIH) Asthma Outcomes Task force to summarize relevant outcomes for NIH asthma research. One of the sections was on physiology and listed various physiologic measures as core (should be included in all asthma research), supplementary (applied in selected research), and exploratory (intended to be evaluated for potential application).58 AHR by methacholine challenge was listed as a supplemental measure. Pralong et al59
New information on asthma medications
In 2016, promising new medications as add-on management for poorly controlled asthma were introduced, and the safety of well-established medications, namely LABAs, was revisited. The addition of roflumilast, a selective phosphodiesterase 4 inhibitor, in conjunction with montelukast to the controller regimen of adults with inadequately controlled asthma despite the use of at least medium-dose ICSs with a LABA resulted in a statistically significant increase in prebronchodilator FEV1 from
Management
In 2016, emphasis was placed on assessment of medication adherence and creation of comprehensive school-based asthma support networks (Table V).39, 87, 88, 89, 90 In a population-based cohort study, only 33% of pediatric patients demonstrated high ICS adherence.91 Similarly, by using reimbursement data, only 24% of adults and pediatric patients maintained regular ICS adherence 1 year after a period of regular ICS use.87 The unique barriers for poor medication adherence are age specific,
Summary
As indicated in this summary, there are rapid areas of development related to the natural history of asthma and the effect of the environment (Table VI).2, 7, 9, 23, 29, 35, 40, 51, 56, 64, 91, 94 There has been no previous era in asthma management that has witnessed the introduction of so many new classes of medications. It will be a challenge for clinicians and those contributing to asthma guidelines to select relevant pieces of information that should be incorporated into clinical practice.
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Doublesex and mab-3–related transcription factor 1 (DMRT1) is a sex-specific genetic determinant of childhood-onset asthma and is expressed in testis and macrophages
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Identification of a new locus at 16q12 associated with time to asthma onset
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Regulation of T cell receptor signaling by DENND1B in TH2 cells and allergic disease
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United Nations Climate Change Conferences: COP21 a lost opportunity for asthma and allergies and preparing for COP22
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Early life exposure to traffic-related air pollution and lung function in adolescence assessed with impulse oscillometry
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A combination of dexamethasone and anti-IL-17A treatment can alleviate diesel exhaust particle-induced steroid insensitive asthma
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Pathways through which asthma risk factors contribute to asthma severity in inner-city children
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Early sensitization is associated with reduced lung function from birth into adulthood
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Prenatal and postnatal stress and asthma in children: temporal- and sex-specific associations
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Patient-centered outcomes research to improve asthma outcomes
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Using stakeholder engagement to develop a patient-centered pediatric asthma intervention
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Home visits are needed to address asthma health disparities in adults
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Care transition interventions for children with asthma in the emergency department
J Allergy Clin Immunol
Enrolling African-American and Latino patients with asthma in comparative effectiveness research: lessons learned from 8 patient-centered studies
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Assessing differences in inhaled corticosteroid response by self-reported race-ethnicity and genetic ancestry among asthmatic subjects
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Asthma in Puerto Ricans: lessons from a high-risk population
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Asthma phenotypes in inner-city children
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Distinguishing characteristics of difficult-to-control asthma in inner-city children and adolescents
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Precision medicine and precision health: building blocks to foster a revolutionary health care model
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Toward precision medicine and health: Opportunities and challenges in allergic diseases
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Personalized asthma therapy in blacks-the role of genetic ancestry
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A novel anti-IL-33 antibody recognizes an epitope FVLHN of IL-33 and has a therapeutic effect on inflammatory diseases
2023, International ImmunopharmacologyFerroptosis participates in dibutyl phthalate-aggravated allergic asthma in ovalbumin-sensitized mice
2023, Ecotoxicology and Environmental SafetyAdvances in understanding and reducing the burden of severe asthma in children
2020, The Lancet Respiratory MedicineAsthma: Environmental and occupational risk factors
2019, Encyclopedia of Environmental HealthAsthma across the lifespan: Time for a paradigm shift
2018, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Each year, the Journal has summarized key literature related to advances in asthma research.29 In the past 2 years, a number of new medications and strategies have been added to our armamentarium for asthma management, including tiotropium; biologics, such as omalizumab and anti–IL-5 agents (mepolizumab, reslizumab, and benralizumab); and bronchial thermoplasty, with varying levels of approval for use in children along with several other medications, such as anti–IL-4/IL-13 (dupilumab) and perhaps anti–thymic stromal lymphopoietin, that await approval for asthma.29-31 It is exciting to see a number of useful tools for managing asthma but discouraging to see that they are not readily applied.
Impact of Passive Smoking on Lung Function and Asthma Severity in Children
2018, Archivos de Bronconeumologia
Disclosure of potential conflict of interest: S. J. Szefler serves as a consultant for Roche, AstraZeneca, Aerocrine, Daiichi Sankyo, Boehringer Ingelheim, Merck, Genentech, Novartis, and Teva and receives grant support from GlaxoSmithKline. The rest of the authors declare that they have no relevant conflicts of interest.