Asthma is a heterogeneous disease with multiple phenotypes that have variable risk factors and responses to therapeutics. Mild-to-moderate asthma often responds to traditional medications, whereas severe disease can be refractory to inhaled corticosteroids, long-acting β-agonists, and leukotriene receptor antagonists. There is robust research into the variable phenotypes of asthma. Biomarkers help define the specific pathophysiology of different asthma phenotypes and identify potential therapeutic targets. The following review will discuss the current use of biomarkers for the diagnosis of asthma, triaging the severity of a patient's disease, and the potential efficacy of treatments. This information can be used to define certain patient populations that are more likely to respond to inhaled corticosteroids or biologics. As knowledge of patient phenotypes and endotypes and biological agents to target specific classes of asthma emerge, the ability to provide personalized care to asthmatic patients will follow.

Background African-Americans have a greater burden from asthma compared to Caucasians. Whether the pattern of airway inflammation differs between African-Americans and Caucasians is unclear. Objective To compare sputum airway inflammatory phenotypes of African-Americans and Caucasians treated or not treated with ICS (ICS+ and ICS-, respectively). Methods We performed a secondary analysis of self-identified African-Americans and Caucasians with asthma enrolled in clinical trials conducted by the National Heart, Lung, and Blood Institute-sponsored Asthma Clinical Research Network and AsthmaNet. Demographics, clinical characteristics, and sputum cytology following sputum induction were examined. We utilized a sputum eosinophil 2% cut point to define individuals with either an eosinophilic (≥2%) or non-eosinophilic (<2%) inflammatory phenotype. Results Among 1,018 participants, African-Americans (n=264) had a lower FEV1% predicted (80 vs. 85%, p<0.01), greater total IgE (197 vs. 120, p<0.01) and a greater proportion with uncontrolled asthma (43% vs. 28%, p<0.01) compared to Caucasians (n=754). There were 922 subjects in the ICS+ group (248 African-Americans, 674 Caucasians) and 298 subjects in the ICS− group (49 African-Americans, 249 Caucasians). Eosinophilic airway inflammation was not significantly different between African-Americans and Caucasians in either group (% with eosinophilic phenotype: ICS+ group: 19% vs. 16%, p=0.28; ICS− group: 39% vs. 35%, p=0.65; respectively). However, when adjusted for confounding factors, African-Americans were more likely to exhibit eosinophilic airway inflammation than Caucasians in the ICS+ group (OR:1.58; CI:1.01–2.48; p=0.046), but not in the ICS− group (p=0.984). Conclusion African-Americans exhibit greater eosinophilic airway inflammation, which may explain the greater asthma burden in this population.

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RATIONALE: Chest radiography is often performed on patients when they are admitted with the diagnosis of bronchiolitis; however, it is unclear as to whether performing chest radiographs in patients with bronchiolitis at admission is useful. The aim of the present study was to determine clinical predictors of chest radiographic abnormalities, in children hospitalized with bronchiolitis in a general hospital. METHODS: All children admitted to our inpatient Pediatric Unit with an episode of acute bronchiolitis from January 2011 to December 2012 were included. The following data were collected at admission: sex, age, neonatal history, past history of hospitalization for respiratory illnesses, heart rate, respiratory rate, presence of fever, fever duration prior to admission, oxygen saturation, laboratory parameters (ie, complete blood cell count, C-reactive protein [CRP], etc) and chest radiography. Nasopharyngeal samples were collected in order to detect respiratory viruses by polymerase chain reaction. RESULTS: The study comprised 355 infants (median age 8 months, boys 60.8%, positive respiratory syncytial virus 23.9%). Among them, 33 children had a chest radiograph revealing focal opacity (n530, 30.8%), or atelectasis (n53, 3.8%). Multivariate logistic regression analysis showed that, after adjusting for potentially confounding factors, the clinical predictors of abnormal chest radiography findings in children hospitalized with bronchiolitis were low oxygen saturation levels (<95%) (adjusted odds ratio [aOR], 0.085; 95% confidence interval [CI], 0.043-0.167; p<0.001) and elevated CRP levels (aOR, 1.211; 95% CI, 1.060-1.384; p50.005). CONCLUSIONS: Among children admitted with bronchiolitis, chest radiographs may be necessary for children with low oxygen saturation (<95%) or high CRP levels at admission.