Editorial

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4 pages, 189 KiB

Open AccessEditorial

Asthma: From Phenotypes to Personalized Medicine

by

Petros Bakakos

J. Pers. Med. 2022, 12(11), 1853; https://doi.org/10.3390/jpm12111853 - 06 Nov 2022

Cited by 1 | Viewed by 941

Abstract

Asthma is a heterogeneous disease of the airways with a high prevalence worldwide characterized by chronic inflammation [...] Full article

(This article belongs to the Special Issue Asthma: From Phenotypes to Personalized Medicine)

Review

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14 pages, 748 KiB

Open AccessReview

Asthma and Tobacco Smoking

by

Vanesa Bellou

,

Athena Gogali

and

Konstantinos Kostikas

J. Pers. Med. 2022, 12(8), 1231; https://doi.org/10.3390/jpm12081231 - 27 Jul 2022

Cited by 3 | Viewed by 2384

Abstract

Asthma is a prevalent chronic pulmonary condition with significant morbidity and mortality. Tobacco smoking is implicated in asthma pathophysiology, diagnosis, prognosis and treatment. Smokers display increased prevalence and incidence of asthma, but a causal association cannot be claimed using existing evidence. Second-hand smoking [...] Read more.

Asthma is a prevalent chronic pulmonary condition with significant morbidity and mortality. Tobacco smoking is implicated in asthma pathophysiology, diagnosis, prognosis and treatment. Smokers display increased prevalence and incidence of asthma, but a causal association cannot be claimed using existing evidence. Second-hand smoking and passive exposure to tobacco in utero and early life have also been linked with asthma development. Currently, approximately one-fourth of asthma patients are smokers. Regular smokers with asthma might display accelerated lung function decline and non-reversible airflow limitation, making their distinction from chronic obstructive pulmonary disease patients challenging. Asthma patients who smoke typically have uncontrolled disease, as shown by increased symptoms, more exacerbations and impaired quality of life. On the other hand, smoking cessation improves lung function and asthma severity. Thus, asthma patients and their caregivers should be actively questioned about their smoking status at each medical encounter, and smoking cessation ought to be strongly encouraged both for patients with asthma and their close contacts. Smokers with asthma should be provided with comprehensive smoking cessation interventions on top of other anti-asthma medications. Full article

(This article belongs to the Special Issue Asthma: From Phenotypes to Personalized Medicine)

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17 pages, 596 KiB

Open AccessReview

Allergic Asthma in the Era of Personalized Medicine

by

Niki Papapostolou

and

Michael Makris

J. Pers. Med. 2022, 12(7), 1162; https://doi.org/10.3390/jpm12071162 - 18 Jul 2022

Cited by 9 | Viewed by 3296

Abstract

Allergic asthma is the most common asthma phenotype and is characterized by IgE sensitization to airborne allergens and subsequent typical asthmatic symptoms after exposure. A form of type 2 (T2) airway inflammation underlies allergic asthma. It usually arises in childhood and is accompanied [...] Read more.

Allergic asthma is the most common asthma phenotype and is characterized by IgE sensitization to airborne allergens and subsequent typical asthmatic symptoms after exposure. A form of type 2 (T2) airway inflammation underlies allergic asthma. It usually arises in childhood and is accompanied by multimorbidity presenting with the occurrence of other atopic diseases, such as atopic dermatitis and allergic rhinitis. Diagnosis of the allergic endotype is based on in vivo (skin prick tests) and/or in vitro (allergen-specific IgE levels, component-resolved diagnosis (CRD)) documentation of allergic sensitization. Biomarkers identifying patients with allergic asthma include total immunoglobulin E (IgE) levels, fractional exhaled nitric oxide (FeNO) and serum eosinophil counts. The treatment of allergic asthma is a complex procedure and requires a patient-tailored approach. Besides environmental control involving allergen avoidance measurements and cornerstone pharmacological interventions based on inhaled drugs, allergen-specific immunotherapy (AIT) and biologics are now at the forefront when it comes to personalized management of asthma. The current review aims to shed light on the distinct phenotype of allergic asthma, ranging over its current definition, clinical characteristics, pathophysiology and biomarkers, as well as its treatment options in the era of precision medicine. Full article

(This article belongs to the Special Issue Asthma: From Phenotypes to Personalized Medicine)

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18 pages, 1067 KiB

Open AccessReview

Eosinophilic Asthma, Phenotypes-Endotypes and Current Biomarkers of Choice

by

Konstantinos Porpodis

,

Ioanna Tsiouprou

,

Apostolos Apostolopoulos

,

,

,

,

and

J. Pers. Med. 2022, 12(7), 1093; https://doi.org/10.3390/jpm12071093 - 30 Jun 2022

Cited by 9 | Viewed by 5444

Abstract

Asthma phenotyping and endotyping are constantly evolving. Currently, several biologic agents have been developed towards a personalized approach to asthma management. This review will focus on different eosinophilic phenotypes and Th2-associated endotypes with eosinophilic inflammation. Additionally, airway remodeling is analyzed as a key [...] Read more.

Asthma phenotyping and endotyping are constantly evolving. Currently, several biologic agents have been developed towards a personalized approach to asthma management. This review will focus on different eosinophilic phenotypes and Th2-associated endotypes with eosinophilic inflammation. Additionally, airway remodeling is analyzed as a key feature of asthmatic eosinophilic endotypes. In addition, evidence of biomarkers is examined with a predictive value to identify patients with severe, uncontrolled asthma who may benefit from new treatment options. Finally, there will be a discussion on the results from clinical trials regarding severe eosinophilic asthma and how the inhibition of the eosinophilic pathway by targeted treatments has led to the reduction of recurrent exacerbations. Full article

(This article belongs to the Special Issue Asthma: From Phenotypes to Personalized Medicine)

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12 pages, 284 KiB

Open AccessEditor’s ChoiceReview

Biologic Therapies in Pediatric Asthma

by

Evanthia P. Perikleous

,

Paschalis Steiropoulos

,

Evangelia Nena

and

Emmanouil Paraskakis

J. Pers. Med. 2022, 12(6), 999; https://doi.org/10.3390/jpm12060999 - 18 Jun 2022

Cited by 12 | Viewed by 2307

Abstract

Undeniably, childhood asthma is a multifactorial and heterogeneous chronic condition widespread in children. Its management, especially of the severe form refractory to standard therapy remains challenging. Over the past decades, the development of biologic agents and their subsequent approval has provided an advanced [...] Read more.

Undeniably, childhood asthma is a multifactorial and heterogeneous chronic condition widespread in children. Its management, especially of the severe form refractory to standard therapy remains challenging. Over the past decades, the development of biologic agents and their subsequent approval has provided an advanced and very promising treatment alternative, eventually directing toward a successful precision medicine approach. The application of currently approved add-on treatments for severe asthma in children, namely omalizumab, mepolizumab, benralizumab, dupilumab, and tezepelumab have been shown to be effective in terms of asthma control and exacerbation rate. However, to date, information is still lacking regarding its long-term use. As a result, data are frequently extrapolated from adult studies. Thus, the selection of the appropriate biologic agent, the potential predictors of good asthma response, and the long-term outcome in the pediatric population are still to be further investigated. The aim of the present study was to provide an overview of the current status of the latest evidence about all licensed monoclonal antibodies (mAbs) that have emerged and been applied to the field of asthma management. The innovative future targets are also briefly discussed. Full article

(This article belongs to the Special Issue Asthma: From Phenotypes to Personalized Medicine)

14 pages, 292 KiB

Open AccessEditor’s ChoiceReview

Biological Therapy of Severe Asthma and Nasal Polyps

by

Agamemnon Bakakos

,

Florence Schleich

and

Petros Bakakos

J. Pers. Med. 2022, 12(6), 976; https://doi.org/10.3390/jpm12060976 - 16 Jun 2022

Cited by 13 | Viewed by 2998

Abstract

Chronic rhinosinusitis is a common disease worldwide and can be categorized into chronic rhinosinusitis with nasal polyps and chronic rhinosinusitis without nasal polyps. Chronic rhinosinusitis with nasal polyps is common in patients with asthma and, particularly, severe asthma. Severe asthma is effectively treated [...] Read more.

Chronic rhinosinusitis is a common disease worldwide and can be categorized into chronic rhinosinusitis with nasal polyps and chronic rhinosinusitis without nasal polyps. Chronic rhinosinusitis with nasal polyps is common in patients with asthma and, particularly, severe asthma. Severe asthma is effectively treated with biologics and the coexistence of severe asthma with chronic rhinosinusitis with nasal polyps presents a phenotype that is more likely to respond to such treatment. In this review, we focus on the link between asthma and nasal polyps, and we review the treatment effect of various monoclonal antibodies in patients with severe asthma and nasal polyps as well as in patients with nasal polyps without asthma or with mild-to-moderate asthma. With the enhancement of our armamentarium with new monoclonal antibodies the right choice of biologic becomes an important target and one that is difficult to achieve due to the lack of comparative head-to-head studies. Full article

(This article belongs to the Special Issue Asthma: From Phenotypes to Personalized Medicine)

13 pages, 869 KiB

Open AccessReview

Paucigranulocytic Asthma: Potential Pathogenetic Mechanisms, Clinical Features and Therapeutic Management

by

Andriana I. Papaioannou

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,

,

and

J. Pers. Med. 2022, 12(5), 850; https://doi.org/10.3390/jpm12050850 - 23 May 2022

Cited by 8 | Viewed by 2414

Abstract

Asthma is a heterogeneous disease usually characterized by chronic airway inflammation, in which several phenotypes have been described, related to the age of onset, symptoms, inflammatory characteristics and treatment response. The identification of the inflammatory phenotype in asthma is very useful, since it [...] Read more.

Asthma is a heterogeneous disease usually characterized by chronic airway inflammation, in which several phenotypes have been described, related to the age of onset, symptoms, inflammatory characteristics and treatment response. The identification of the inflammatory phenotype in asthma is very useful, since it allows for both the recognition of the asthmatic triggering factor as well as the optimization of treatment The paucigranulocytic phenotype of asthma (PGA) is characterized by sputum eosinophil levels <1–3% and sputum neutrophil levels < 60%. The precise characteristics and the pathobiology of PGA are not fully understood, and, in some cases, it seems to represent a previous eosinophilic phenotype with a good response to anti-inflammatory treatment. However, many patients with PGA remain uncontrolled and experience asthmatic symptoms and exacerbations, irrespective of the low grade of airway inflammation. This observation leads to the hypothesis that PGA might also be either a special phenotype driven by different kinds of cells, such as macrophages or mast cells, or a non-inflammatory phenotype with a low grade of eosinophilic inflammation. In this review, we aim to describe the special characteristics of PGA and the potential therapeutic interventions that could be offered to these patients. Full article

(This article belongs to the Special Issue Asthma: From Phenotypes to Personalized Medicine)

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15 pages, 635 KiB

Open AccessReview

Asthma-COPD Overlap Syndrome: Recent Insights and Unanswered Questions

by

Evangelia Fouka

,

Andriana I. Papaioannou

,

Georgios Hillas

and

Paschalis Steiropoulos

J. Pers. Med. 2022, 12(5), 708; https://doi.org/10.3390/jpm12050708 - 28 Apr 2022

Cited by 8 | Viewed by 3058

Abstract

The term asthma-COPD overlap (ACO) has been used to identify a heterogeneous condition in which patients present with airflow limitation that is not completely reversible and clinical and inflammatory features of both asthma and chronic obstructive pulmonary disease (COPD). ACO diagnosis may be [...] Read more.

The term asthma-COPD overlap (ACO) has been used to identify a heterogeneous condition in which patients present with airflow limitation that is not completely reversible and clinical and inflammatory features of both asthma and chronic obstructive pulmonary disease (COPD). ACO diagnosis may be difficult in clinical practice, while controversy still exists regarding its definition, pathophysiology, and impact. Patients with ACO experience a greater disease burden compared to patients with asthma or COPD alone, but in contrast they show better response to inhaled corticosteroid treatment than other COPD phenotypes. Current management recommendations focus on defining specific and measurable treatable clinical traits, according to disease phenotypes and underlying biological mechanisms for every single patient. In this publication, we review the current knowledge on definition, pathophysiology, clinical characteristics, and management options of ACO. Full article

(This article belongs to the Special Issue Asthma: From Phenotypes to Personalized Medicine)

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15 pages, 496 KiB

Open AccessReview

Asthma with Fixed Airflow Obstruction: From Fixed to Personalized Approach

by

,

,

and

J. Pers. Med. 2022, 12(3), 333; https://doi.org/10.3390/jpm12030333 - 23 Feb 2022

Cited by 10 | Viewed by 2518

Abstract

Asthma is generally characterized by variable symptoms such as dyspnea and wheezing and variable airflow obstruction. This review focuses on a subset of patients suffering from asthma with persistent airflow limitation that is not fully reversible (asthma with fixed airflow obstruction, FAO). The [...] Read more.

Asthma is generally characterized by variable symptoms such as dyspnea and wheezing and variable airflow obstruction. This review focuses on a subset of patients suffering from asthma with persistent airflow limitation that is not fully reversible (asthma with fixed airflow obstruction, FAO). The pathophysiology, the risk factors and the clinical outcomes associated with FAO are presented, as well as the distinct clinical entity of severe asthma and its inflammatory subtypes (T2 and non-T2). The current strategies for the treatment of these endotypes and treatment of the distinct Asthma/COPD overlap (ACO) phenotype are described. Management and medical interventions in FAO and/or ACO patients demand a holistic approach, which is not yet clearly established in guidelines worldwide. Finally, a treatment algorithm that includes FAO/ACO management based on pharmacological and non-pharmacological treatment, guideline-based management for specific co-morbidities, and modification of the risk factors is proposed. Full article

(This article belongs to the Special Issue Asthma: From Phenotypes to Personalized Medicine)

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