Photo Credit: Dr Microbe
The following is a summary of “Burden of Uncontrolled Severe Asthma With and Without Elevated Type-2 Inflammatory Biomarkers,” published in the April 2024 issue of Allergy & Immunology by Ding, et al.
A substantial proportion of patients with asthma exhibit type-2 airway inflammation, characterized by biomarkers such as a history of allergy, elevated blood eosinophil (EOS) count, and increased fractional exhaled nitric oxide (FeNO) levels. For a study, researchers sought to evaluate the disease burden associated with type-2 inflammatory biomarker status (including history of allergy, blood EOS count, and FeNO level) in patients with uncontrolled and controlled severe asthma, as part of the NOVEL observational longiTudinal studY (NOVELTY).
Physician-reported asthma diagnosis and severity were assessed. Control was determined based on the Asthma Control Test (ACT) score (uncontrolled <20, controlled ≥20) and/or the presence of one or more severe physician-reported exacerbations in the preceding year. Biomarker distribution, symptom burden (ACT score, modified Medical Research Council [mMRC] dyspnea scale), health status (St George’s Respiratory Questionnaire [SGRQ] score), exacerbations, and healthcare resource utilization were evaluated.
Among the 647 patients with severe asthma, 446 had uncontrolled, and 123 had controlled asthma. In the uncontrolled asthma group, 196 (44%) exhibited two or more positive biomarkers, 187 (42%) had one positive biomarker, 325 (73%) had low blood EOS counts, and 63 (14%) were triple-negative. Despite biomarker status, disease burden remained consistently high across uncontrolled subgroups, characterized by poor symptom control (ACT score 14.9-16.6), impaired health status (SGRQ total score 46.7-49.4), clinically significant breathlessness (mMRC grade ≥2 in 47.3%-57.1%), and one or more severe exacerbations (70.6%-76.2%).
Type-2 inflammatory biomarkers failed to differentiate disease burden in patients with severe asthma. Patients with low levels of type-2 inflammatory biomarkers have limited options for biologic therapy, underscoring the need to address their specific needs.
Reference: jaci-inpractice.org/article/S2213-2198(23)01372-7/fulltext
