Improving the diagnosis of eosinophilic asthma

Coumou, Hanneke; Bel, Elisabeth H.

doi:10.1080/17476348.2017.1236688

Cited by 41 publications

(38 citation statements)

References 95 publications

(150 reference statements)

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“…When using FENO and blood eosinophils, our data show that we can only achieve a satisfactory prediction in 45% of patients, which is not very different from what Hastie et al reported. We also found that measuring total IgE may be of interest as the proportion of asthmatics accurately predicted rose from 45 to 58% of the population, which supports the idea that combining biomarkers is useful [13]. …”

Section: Discussionsupporting

confidence: 67%

Is it possible to claim or refute sputum eosinophils ≥ 3% in asthmatics with sufficient accuracy using biomarkers?

et al. 2017

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The concept of asthma inflammatory phenotypes has proved to be important in predicting response to inhaled corticosteroids. Induced sputum, which has been pivotal in the development of the concept of inflammatory phenotypes, is however not widely available. Several studies have proposed to use surrogate exhaled or blood biomarkers, like fractional exhaled nitric oxide (FENO), blood eosinophils and total serum immunoglobulin E (IgE). However, taken alone, each of these biomarkers has moderate accuracy to identify sputum eosinophilia. Here, we propose a new approach based on the likelihood ratio to study which thresholds of these biomarkers, taken alone or in combination, were able to rule in or rule out sputum eosinophils ≥3%. We showed in a large population of 869 asthmatics that combining FENO, blood eosinophils and total serum IgE could accurately predict sputum eosinophils ≥ or <3% in 58% of our population.

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Section: Discussionsupporting

confidence: 67%

Is it possible to claim or refute sputum eosinophils ≥ 3% in asthmatics with sufficient accuracy using biomarkers?

et al. 2017

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“…This might reflect that the blood eosinophil count is an attractive biomarker because of the ease of availability and its potential to identify patients with asthma eligible for treatment with novel therapeutics. In contrast, the measurement of sputum eosinophils is time-consuming and requires specific technical expertise not generally available in clinical settings [32]. Nonetheless, sputum eosinophil counts have been helpful in characterizing airway inflammation, predicting response to corticosteroid treatment, and identifying patients at risk of exacerbations [33–35].…”

Section: Discussionmentioning

confidence: 99%

Health care resource utilization and characteristics of patients with eosinophilic asthma in secondary health care in Finland

Mäkelä

Christensen

Karlsson

et al. 2018

European Clinical Respiratory Journal

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Background: Eosinophilic airway inflammation is common in asthma patients and appears to be associated with severe exacerbations and loss of asthma control. Objective: To describe the resource utilization and clinical characteristics of patients with eosinophilic asthma. Design: Asthma patients ≥18 years with ≥1 blood eosinophil count in secondary care (South West Finland) during 2003‒2013 were included. Clinical characteristics (age, lung function, body mass index, and comorbidities) and asthma-related resource utilization (hospital admissions, outpatient visits, and emergency room [ER] visits) were retrieved. Resource utilization rates were compared for patients with blood eosinophil ≤ or >300 cells/μL, using adjusted negative binomial regression models. Results: Overall, 4,357 eligible patients were identified (mean age 60 years, females 68%), of which 1,927 (44%) had >300 eosinophil cells/μL blood. Patients with ≤300 and >300 eosinophil counts, exhibited similar clinical characteristics, including advanced age, poor lung function, and overweight. Comorbidities such as pneumonia, sinusitis, and nasal polyps, were more frequent among those with >300 eosinophil cells/μL blood compared with patients with lower counts. Eosinophil counts >300 cells/μL were associated with greater hospital admissions (rate ratio [RR] [95% confidence interval CI]: 1.13 [1.02;1.24]) and outpatient visits (RR [95% CI]: 1.11 [1.03;1.20]) compared with patients with lower eosinophil counts. Rates of ER visits were similar between the patient groups (RR [95% CI]: 0.99 [0.87;1.12]). Conclusions: Hospital admissions and outpatient visits occurred more often for patients with eosinophil counts >300 cells/µL, than for patients with lower eosinophil counts. Routine blood eosinophil screening might be useful to identify patients with an eosinophilic phenotype eligible for more targeted treatments.

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“…The results of the current analyses underscore the potential limitations of defining probable responders to eosinophil depletion therapy, based on a blood eosinophil count of !300 cells/lL alone. More detailed characterization of the eosinophilic phenotype beyond blood eosinophil counts is needed that uses a combination of clinical characteristics (e.g., nasal polyposis), along with blood eosinophil counts 27 . Blood eosinophil counts should be measured at several time points to address variability issues that could cause missed diagnoses for patients with eosinophilic inflammation 32 .…”

Section: Discussionmentioning

confidence: 99%

“…The gold-standard diagnosis of eosinophilic asthma relies on the demonstration of eosinophilic inflammation in the airways, based on bronchial biopsies or induced sputum 27 . These methods are invasive and require specialized training, and are not feasible for routine clinical practice.…”

Section: Discussionmentioning

confidence: 99%

The association between blood eosinophil count and benralizumab efficacy for patients with severe, uncontrolled asthma: subanalyses of the Phase III SIROCCO and CALIMA studies

Goldman

Hirsch

Zangrilli

et al. 2017

Current Medical Research and Opinion

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Improving the diagnosis of eosinophilic asthma

Cited by 41 publications

References 95 publications

Is it possible to claim or refute sputum eosinophils ≥ 3% in asthmatics with sufficient accuracy using biomarkers?

Is it possible to claim or refute sputum eosinophils ≥ 3% in asthmatics with sufficient accuracy using biomarkers?

Health care resource utilization and characteristics of patients with eosinophilic asthma in secondary health care in Finland

The association between blood eosinophil count and benralizumab efficacy for patients with severe, uncontrolled asthma: subanalyses of the Phase III SIROCCO and CALIMA studies

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