What Is New In Small Airways Research
Research Reviews, August 2011
Allergist/Immunologist, Assistant Professor of Pediatrics, University of Chicago
Editor, WAO Small Airways Working Group website
Posted 17 August 2011
Lebrikizumab improves lung function of asthmatic adults with high pretreatment levels of periostin
One potential cause of the variability in response to inhaled corticosteroid treatment is heterogeneity in the interleukin-13 expression in asthma. This randomized, double-blind, placebo-controlled study of lebrikizumab, a monoclonal antibody to interleukin-13, included 219 adults with poorly controlled asthma despite inhaled glucocorticoid therapy. The primary outcome was the change in FEV1 from baseline to week 12. At baseline, patients had a mean FEV1 that was 65% of the predicted value and were taking a mean dose of inhaled glucocorticoids of 580 μg per day; 80% were also taking a long-acting beta-agonist. At week 12, the increase in FEV1 was higher in the lebrikizumab group but the difference was statistically significant only in patients with high-periostin (8.2%, P=0.02). Musculoskeletal side effects were more common with lebrikizumab than with placebo. The study shows the potential of using targeted therapies in sub-populations with difficult to control asthma. However, lebrikizumab treatment did not reduce rates of asthma exacerbations or asthma symptoms. The study was funded by the lebrikizumab manufacturer, Genentech.
Source: Corren J, Lemanske RF, Hanania NA, Korenblat PE, Parsey MV, Arron JR, Harris JM, Scheerens H, Wu LC, Su Z, Mosesova S, Eisner MD, Bohen SP, Matthews JG. Lebrikizumab Treatment in Adults with Asthma. N Engl J Med. 2011 Aug 3. [Epub ahead of print]
Inhaled corticosteroid formulation, particle size, and lung deposition may play important role in real-life effectiveness of asthma therapy
The extrafine-particle formulation of hydrofluoroalkane–beclometasone (EF HFA-BDP, Qvar) demonstrates improved airway deposition compared with large-particle chlorofluorocarbon (CFC)–BDP. This retrospective matched cohort study examined outcomes in a database for patients aged 5–60 years with asthma receiving their first inhaled corticosteroid (ICS) prescription or first ICS dose increase by a metered-dose inhaler as EF HFA–BDP or CFC–BDP. EF HFA–BDP was prescribed at a dose half that of CFC–BDP. Primary endpoints were asthma control and exacerbation rate during the outcome year. Patients who received EF HFA–BDP were more likely to achieve asthma control than those receiving CFC–BDP during 1 year after initiating (odds ratio 1.15) or stepping up ICS therapy (odds ratio 1.72). Extra-fine particle formulation of beclometasone can be used at half the dose of the large-particle formulation with at least as good clinical outcomes. However, a prospective, randomized, double-blind clinical trial would be needed before any final conclusions can be drawn from this study.
Source: Barnes N, Price D, Colice G, Chisholm A, Dorinsky P, Hillyer EV, Burden A, Lee AJ, Martin RJ, Roche N, von Ziegenweidt J, Israel E. Asthma control with extrafine-particle hydrofluoroalkane-beclometasone vs. large-particle chlorofluorocarbon-beclometasone: a real-world observational study. Clin Exp Allergy. 2011 Jul 14. doi: 10.1111/j.1365-2222.2011.03820.x. [Epub ahead of print]
Exposure at work to dampness and molds associated with new-onset asthma
This study included 483 patients with asthma-like symptoms related to damp workplaces but without evidence of asthma in baseline examinations. The development of asthma and present work conditions were established with the use of a questionnaire 3–12 years later. During the study period, 13% of patients developed asthma. Continued exposure to a damp or moldy environment was associated with a more than fourfold increase in the risk of asthma (odds ratio 4.6, 95% confidence interval 1.8–11.6). Working in a non-remediated environment at follow-up was the strongest risk factor for developing asthma.
Source: Karvala K, Toskala E, Luukkonen R, Uitti J, Lappalainen S, Nordman H. Prolonged exposure to damp and moldy workplaces and new-onset asthma. Int Arch Occup Environ Health. 2011 Jul 19. [Epub ahead of print]
Posted 17 August 2011