What Is New In Small Airways Research
By Ves Dimov, MD
Allergist/Immunologist, Assistant Professor, University of Chicago
Omalizumab decreases hospitalization or ED visits in patients with uncontrolled severe asthma in real-life practice
This study cohort from France included 374 adult patients with uncontrolled severe asthma despite optimal treatment with inhaled and oral corticosteroids and a long-acting beta 2-agonist (ICS/LABA). Omalizumab (anti-IgE monoclonal antibody) was added to their therapy. The patients took omalizumab at least once during the mean observation period just short of 2 years (20 months).
Omalizumab was associated with a relative risk of 0.57 for hospitalization or ED visits for asthma. The relative risk of hospitalization or ED visits for asthma during omalizumab treatment vs nontreatment periods was 0.40. The calculated risk was controlled for the standard variables such as age, sex, smoking history, BMI, gastroesophageal reflux, allergic status, allergic rhinitis, etc.
Add-on omalizumab was associated with a significantly decreased risk of hospitalization or ED visits in patients with uncontrolled severe asthma in real-life practice.
Source: Grimaldi-Bensouda L, Zureik M, Aubier M, Humbert M, Levy J et al, Pharmacoepidemiology of Asthma and Xolair (PAX) Study Group. Does omalizumab make a difference to the real-life treatment of asthma exacerbations?: Results from a large cohort of patients with severe uncontrolled asthma. Chest 2013; 143(2):398-405.
Exhaled nitric oxide in symptomatic children at preschool age predicts later asthma
This prospective study from Switzerland included 391 preschool children with lower airway symptoms. It assessed if the fraction of exhaled nitric oxide (FeNO) is associated with asthma later in their lives, at school age. At follow-up, primary outcome was physician-diagnosed asthma based during school age (166 children completed the study).
FeNO was elevated in the children with later asthma vs. children not developing asthma. Median FeNO was 10.5 vs 7.4 ppb.
Per 5 ppb FeNO increase, the odds ratio for asthma increased by 2.44 without changing when adjusting for confounders. Using the new risk model, children scored at risk had 58% probability for later asthma, whereas the negative predictive value was 78.2%. This risk model is comparable to the classical asthma predictive index (API) but does not require blood sampling.
In this cohort of high-risk preschool children, elevated FeNO is associated with increased risk for school-age asthma.
Source: Singer F, Luchsinger I, Inci D, Knauer N, Latzin P et al. Exhaled nitric oxide in symptomatic children at preschool age predicts later asthma. Allergy 2013; 68(4):531-538. doi: 10.1111/all.12127
Allergic sensitization in older patients with asthma more common than previously reported: 65% were sensitized
Approximately 60% to 80% of children and young adults with asthma are sensitized to at least one allergen. In contrast, previous studies of older patients with asthma suggested that allergic sensitization was significantly lower.
This study from Mount Sinai School of Medicine in New York included data from the National Health and Nutrition Examination Survey (NHANES) 2005-2006 to compare IgE-mediated sensitization rates between younger (20-40 years) and older (≥55 years) patients with current asthma. Atopy was defined as a serum IgE to at least 1 allergen in a panel of 19 allergens.
Allergic sensitization rates did not differ significantly between the age groups; 75.4% of the younger and 65.2% of the older asthmatic patients were sensitized to at least 1 allergen.
Allergic sensitization in older patients with asthma may be more common than previously reported.
Source: Busse PJ, Cohn RD, Salo PM, Zeldin DC. Characteristics of allergic sensitization among asthmatic adults older than 55 years: results from the National Health and Nutrition Examination Survey, 2005-2006. Annals of Allergy, Asthma & Immunology. 2013; 110(4):247-52. doi: 10.1016/j.anai.2013.01.016