Asthma is characterized by variable airway obstruction, airway hyperresponsiveness, and airway inflammation. Management of persistent asthma requires avoidance of aggravating environmental factors, use of short-acting β2-agonists for rapid relief of symptoms, and daily use of inhaled corticosteroids. Other controller medications, such as long-acting bronchodilators and biologics, may be required in moderate and severe asthma. Patients with severe asthma generally benefit from consultation with an asthma specialist for consideration of additional treatment, including injectable biologic agents.

Purpose Current asthma management relies on inhaled corticosteroids, but some asthma is not well controlled with inhaled steroids alone or in combination with long-acting bronchodilators or leukotriene pathway inhibitors. The field of biologic therapy has grown dramatically in the past two decades, with current availability of three molecules, with two distinct, and highly selective approaches to interfering with the allergic and eosinophilic airway inflammation common to most asthma. This review summarizes current and future options for incorporating biologic therapy into the overall management of asthma. Recent Findings Two new biologic agents have recently come on the US market, supported by well-controlled, randomized clinical trials. These trials have provided insight into the types of patients who are most likely to benefit from these novel agents. Summary In asthma patients with frequent exacerbations, the addition of a biologic agent targeting the IL-5 pathway, or IgE, can significantly reduce exacerbations and improve asthma control. The clinical predictors of utility of specific agents overlap with one another, highlighting the importance of clinical judgment in the overall management of this complex disorder.

Week 96 data confirm week 48 observations in MERIT.

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RATIONALE: Lipoxygenase-(LOX) and cyclooxygenase-derived products participate in regulation of inflammatory response. To evaluate the role of 12/15-LOX in modulation of gene expression in the lungs during experimental Dermatophagoides pteronyssinus-(Dp) induced airway inflammation. METHODS: Allergic airway inflammation was induced in wild type C57Bl and 12/15-LOX knockout (12/15-KO) mice by sensitization and exposure to Dp. Lung samples were obtained 24 hours after: 1. a single nebulization (SN, n58), or 2. a series of repeated nebulizations performed once daily for 3 weeks (RN, n58). Sham challenged mice were used as controls. Expression of 84 genes was evaluated using SYBR Green-based microarray. The expression of the selected genes was verified using TaqMan-based real-time PCR. RESULTS: After SN in C57Bl mice significant (>2-fold) up-regulation of Ccl17, Clca3, Csf3r, Ear11, Il17a, Il9 and Retnlg expression was demonstrated. After RN significant up-regulation of expression of 44 genes was found in C57Bl mice. The strongest up-regulation (>10-fold) was demonstrated for Arg1,

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