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What Is New In Small Airways Research

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Ves Dimov, M.D.
Cleveland Clinic Florida
Weston, Florida

4 asthma phenotype clusters in elderly patients identified for the first time

This is reportedly the first attempt to classify asthma phenotypes in the elderly population.

The large research team from South Korea applied k-means cluster to 872 elderly patients with asthma (aged over 65 years) in a prospective, multi-centered cohort over the course of 2 years.

4 phenotype clusters of elderly patients with asthma were identified:

  • Long symptom duration and marked airway obstruction
  • Female dominance and normal lung function
  • Smoking male dominance and reduced lung function
  • High body mass index (BMI) and borderline lung function

Cluster grouping was predictive of asthma exacerbations. Decision-tree algorithm included 2 variables, FEV1 and smoking pack-years.

Source: Park HW, Song WJ, Kim SH, Park HK, Kim SH et al. Classification and implementation of asthma phenotypes in elderly patients. Annals of Allergy, Asthma & Immunology 2014; published online ahead of print, 23 October. (doi:

Image Source: Asthma, FDA newsletter and Wikipedia; public domain

Nonallergic asthma occurs in 10-33% of asthmatics, has later onset than allergic asthma, female predominance

A category of asthma termed “intrinsic” was described more than 50 years ago, but the debate whether this entity has distinct features, or should be abandoned, continues.

The definition of nonallergic asthma includes patients with asthma and in whom allergic sensitization cannot be demonstrated. These individuals should have negative skin prick test or in vitro specific-IgE test to a panel of seasonal and perennial allergens. Nonallergic asthma occurs in 10% to 33% of patients and has a later onset than allergic asthma, with a female predominance. Nonallergic asthma appears to be more severe than allergic asthma in many cases and may be less responsive to standard therapy. Patients have a higher expression of Regulated on Activation, Normal T Cell Expressed and Secreted (RANTES) in mucosa and bronchoalveolar lavage fluid, as well as a higher Granulocyte-macrophage colony-stimulating factor (GM-CSF) receptor alpha expression. However, clinical implications remain unclear and further research is needed.

Source: Peters SP. Asthma phenotypes: Nonallergic (intrinsic) asthma.JACI: In Practice 2014; published online ahead of print, 3 October. (doi:
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Budesonide-Formoterol may be slightly better than Fluticasone-Salmeterol for asthma management: US Retrospective Database Analysis

Comparative effectiveness of the budesonide–formoterol fumarate combination (BFC) and the fluticasone propionate–salmeterol combination (FSC) therapy on asthma exacerbation has not been assessed in real-world settings in the United States until this study. The manufacturer of budesonide–formoterol, Astra Zeneca, sponsored the study.

This retrospective cohort comparative effectiveness study queried medical and pharmacy data for 3043 patients with asthma from a large managed care data repository that covers major US population centers. The patients were 12 to 64 years old, with more than 1 year enrollment and pharmacy claim(s) for BFC or FSC between 2007 and 2010.

During the 12 months following the initiation the BFC cohort had lower adjusted exacerbations per person year versus the FSC cohort (0.85 vs 0.93; RR 0.92), lower oral corticosteroid fill rates, and fewer asthma-related emergency department visits but comparable asthma-related hospitalization.

Asthma exacerbation was lower for BFC versus FSC initiators due to lower rates of oral corticosteroid use and asthma-related emergency department visits, which indicate better treatment effectiveness of those patients initiated with BFC compared with FSC.

Source: Tunceli O, Williams SA, Kern DM, Elhefni H, Pethick N, Wessman C, Zhou S, and Trudo F. Comparative effectiveness of Budesonide-Formoterol combination and Fluticasone-Salmeterol combination for asthma management: A United States Retrospective Database Analysis. JACI: In Practice 2014; published online ahead of print, 3 October. (doi:
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Last updated: Thursday, November 6th, 2014