Point-of-care blood eosinophil count in a severe asthma clinic setting

Heffler, Enrico; Terranova, Giovanni; Chessari, Carlo; Frazzetto, Valentina; Crimi, Claudia; Fichera, S.; Picardi, Giuseppe; Nicolosi, Giovanni; Porto, Morena; Intravaia, Rossella; Crimi, Nunzio

doi:10.1016/j.anai.2017.05.016

Cited by 29 publications

(16 citation statements)

References 27 publications

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“…It reflects BAL eosinophilia (15, 18), and, even more importantly, is an excellent biomarker predicting response to anti-TH2 monoclonal antibody strategies (19–21). Peripheral blood eosinophil count can be measured on a finger prick sample with point of care equipment (22). Significantly, in the first attempt at personalized medicine in pre-school children, the combination of a peripheral blood eosinophil count >300/μλ and aeroallergen sensitization was the strongest predictor of response to ICS (23).…”

Section: Current Best Practice: Phenotyping the Airwaymentioning

confidence: 99%

Pathophysiological Mechanisms of Asthma

Bush

2019

Front. Pediatr.

108

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The recent Lancet commission has highlighted that “asthma” should be used to describe a clinical syndrome of wheeze, breathlessness, chest tightness, and sometimes cough. The next step is to deconstruct the airway into components of fixed and variable airflow obstruction, inflammation, infection and altered cough reflex, setting the airway disease in the context of extra-pulmonary co-morbidities and social and environmental factors. The emphasis is always on delineating treatable traits, including variable airflow obstruction caused by airway smooth muscle constriction (treated with short- and long-acting β-2 agonists), eosinophilic airway inflammation (treated with inhaled corticosteroids) and chronic bacterial infection (treated with antibiotics with benefit if it is driving the disease). It is also important not to over-treat the untreatable, such as fixed airflow obstruction. These can all be determined using simple, non-invasive tests such as spirometry before and after acute administration of a bronchodilator (reversible airflow obstruction); peripheral blood eosinophil count, induced sputum, exhaled nitric oxide (airway eosinophilia); and sputum or cough swab culture (bacterial infection). Additionally, the pathophysiology of risk domains must be considered: these are risk of an asthma attack, risk of poor airway growth, and in pre-school children, risk of progression to eosinophilic school age asthma. Phenotyping the airway will allow more precise diagnosis and targeted treatment, but it is important to move to endotypes, especially in the era of increasing numbers of biologicals. Advances in -omics technology allow delineation of pathways, which will be particularly important in TH2 low eosinophilic asthma, and also pauci-inflammatory disease. It is very important to appreciate the difficulties of cluster analysis; a patient may have eosinophilic airway disease because of a steroid resistant endotype, because of non-adherence to basic treatment, and a surge in environmental allergen burden. Sophisticated –omics approaches will be reviewed in this manuscript, but currently they are not being used in clinical practice. However, even while they are being evaluated, management of the asthmas can and should be improved by considering the pathophysiologies of the different airway diseases lumped under that umbrella term, using simple, non-invasive tests which are readily available, and treating accordingly.

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Section: Current Best Practice: Phenotyping the Airwaymentioning

confidence: 99%

Pathophysiological Mechanisms of Asthma

Bush

2019

Front. Pediatr.

108

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“…In the future, it may be possible to routinely determine blood eosinophilia in primary care, as tested in a pilot study using a peripheral blood counter that yielded results perfectly correlated with those of standard blood sampling techniques [27].…”

Section: Blood Eosinophil Countsmentioning

confidence: 99%

Biomarkers for severe allergic asthma in children: could they be useful to guide disease control and use of omalizumab?

Amat

Labbé

2018

Expert Review of Respiratory Medicine

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Although symptom controls in asthmatic children can be achieved through compliant use of conventional medication, some children have uncontrolled severe persistent asthma, especially if they are allergic. For these children, omalizumab (approved by the EMA and FDA in children aged > 6 years) could be a therapeutic option. However, response to omalizumab varies from one child to another. Predictive biomarkers of omalizumab effectiveness could be useful to monitor response to treatment. Area covered: The authors searched in the PubMed database for publications related to the use of biomarkers in allergic asthma. Supported by their own experience in phenotyping asthma in children, they analyzed whether these biomarkers could be useful in assessing response to omalizumab. Expert commentary: Th2 inflammation in children with allergic asthma can be assessed by measuring several biomarkers (blood eosinophil, serum ECP or periostin, FeNO). While a single measurement may be insufficient, a combination of biomarkers assessments may improve the follow-up of children treated by omalizumab.

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“…Severe eosinophilic asthma or eosinophilic refractory asthma is a common phenotype of asthma disease. Higher blood eosinophil count is a well-established risk factor for asthma exacerbation episodes and eosinophil count may decrease after inhaled steroid treatment [16]. Some studies demonstrated that blood eosinophil count is a substantial indicator of economic burden, management and hospitalization rates for asthma [17,18].…”

Section: Discussionmentioning

confidence: 99%

Factors affecting the hospitalization of female patients with asthma

Perinçek¹,

Avcı²

2019

Journal of Surgery and Medicine

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Aim: Asthma is one of the most common chronic respiratory diseases and an important public health problem leading to mortality. The aim of this study was to evaluate the hospitalization rates of female patients with asthma. Methods: This cross-sectional study was conducted with the approval of a university hospital ethics committee between September 2018 and January 2019. The study included a total of 183 females: 56 patients with exacerbation were included in Group 1 and 127 patients with stable asthma constituted Group 2. Demographic data, pulmonary function test results, number of hospital admissions, hospitalization rates and laboratory findings were evaluated. All statistical calculations were performed with SPSS 23 for Windows. Results: The mean age, number of hospitalizations and admissions to the emergency room were significantly higher in Group 1 (P=0.003, P<0.001 and P<0.001, respectively). Patients in Group 1 had lower oxygen saturations, FEV1, FVC, FEV1/FVC values, higher respiratory and heart rates, blood glucose, lactate dehydrogenase, c-reactive protein, lactate, phosphorus, high-density lipoprotein, calcium levels, white blood cell and neutrophil counts. Increased eosinophil count and decreased basophil count were associated with increased emergency room admission rates (P=0.043). Conclusion: Women admitted to the hospital with asthma exacerbation were older and had an increased number of hospitalization rates. Higher eosinophil blood levels were associated with recurrent hospital admissions.

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Point-of-care blood eosinophil count in a severe asthma clinic setting

Cited by 29 publications

References 27 publications

Pathophysiological Mechanisms of Asthma

Pathophysiological Mechanisms of Asthma

Biomarkers for severe allergic asthma in children: could they be useful to guide disease control and use of omalizumab?

Factors affecting the hospitalization of female patients with asthma

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