Advances in the Management of Severe Asthma: From Phenotyping to Personalized Treatment

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (20 October 2023) | Viewed by 2478

Special Issue Editors


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Guest Editor
Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. no. 2, 300041 Timisoara, Romania
Interests: sleep apnea; airways disease; severe asthma; COPD; respiratory infections
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. no. 2, 300041 Timisoara, Romania
Interests: sleep disorders; asthma; COPD; smoking cessation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Asthma is a common, chronic airway disease, affecting 1–18% of the population in different countries. It is estimated that in 3–10% of asthmatics, control of the disease cannot be achieved despite adherence to optimized high-dose ICS-LABA therapy and treatment of contributory factors, or the disease worsens when high-dose treatment is decreased.

The management of severe asthma can pose a significant burden on healthcare systems and usually requires referral to specialized centers. From a patient’s perspective, there is a tremendous negative impact on their quality of life by experiencing symptoms refractory to high-dose inhaled treatment, unexpected exacerbations and side effects of medication. Furthermore, severe asthma also interferes with family, social and working life, and affects emotional and mental health.

In recent years, a better understanding of the pathogenic pathways and the rise of biologic therapy in the field of severe asthma have marked significant progress in the management of this condition. Phenotyping of severe asthma patients has become part of routine practice, allowing for the administration of targeted therapies.

Clinical experience with these new therapeutic agents is still limited and there are many unanswered questions regarding long-term safety issues, duration of treatment, optimal frequency of administration, switching between different agents, modulation of inhaled medication, etc. Real-life evidence is still quite scarce.

Given the extremely high interest in this topic of both researchers and medical practitioners, Medicina is launching a Special Issue entitled “Advances in the Management of Severe Asthma: From Phenotyping to Personalized Treatment”. The aim of this Special Issue is to foster both cutting-edge research reports and insights from clinical experience.

We are pleased to invite submissions of original articles reporting on basic and clinical research in severe asthma, as well as interesting case reports, perspectives, reviews, systematic reviews and meta-analyses focusing on topics such as:

  • New targets for biologic therapy;
  • Optimization of inhaled treatment;
  • Real-life effectiveness of biologic agents;
  • Long-term safety of biologics in severe asthma;
  • Cost/effectiveness ratio of personalized treatment in severe asthma.

Dr. Stefan Frent
Dr. Stefan Mihaicuta
Guest Editors

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Keywords

  • severe asthma
  • phenotypes
  • biologic agents
  • long-term safety
  • economic burden
  • effectiveness
  • inhaled treatment

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Published Papers (1 paper)

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8 pages, 970 KiB  
Case Report
Severe Asthma or Chronic Obstructive Pulmonary Disease with Eosinophilic Inflammation? From Uncertainty to Remission under Anti IL-5R Therapy
by Bianca Oprescu, Oana Raduna, Stefan Mihaicuta and Stefan Frent
Medicina 2024, 60(3), 387; https://doi.org/10.3390/medicina60030387 - 25 Feb 2024
Cited by 2 | Viewed by 2127
Abstract
Background and Objectives: Severe adult-onset eosinophilic asthma and COPD with eosinophilic inflammation are two entities with a similar clinical course and are sometimes difficult to differentiate in clinical practice, especially in patients with a history of smoking. Anti-IL-5 or -IL-5R biological therapy [...] Read more.
Background and Objectives: Severe adult-onset eosinophilic asthma and COPD with eosinophilic inflammation are two entities with a similar clinical course and are sometimes difficult to differentiate in clinical practice, especially in patients with a history of smoking. Anti-IL-5 or -IL-5R biological therapy has been shown to be highly effective in severe eosinophilic asthma but has not demonstrated significant benefit in patients with COPD with the eosinophilic phenotype. Our aim was to illustrate this issue in the form of a case report. Materials and Methods: We present the case of a 67-year-old patient who is a former smoker with late-onset severe uncontrolled asthma (ACT score < 15) who experienced frequent exacerbations requiring treatment with systemic corticosteroids. The patient’s lung function gradually worsened to a nadir FEV1 = 18%, despite a high dose of ICS in combination with a LABA and intermittent courses of OCS, with negative allergic skin-tests, but with high blood eosinophils level. Biological treatment with an anti-IL5R monoclonal antibody (benralizumab) was initiated, despite the difficulty in the differential diagnosis between asthma and COPD with eosinophilic inflammation. Results: The patient’s evolution was favorable; clinical remission was effectively achieved with significant improvement in lung function (FEV1 > 100%), but with persistence of residual mild fixed airway obstructive dysfunction (FEV1/FVC < 0.7). The therapeutic response has been maintained to date. Conclusions: Benralizumab was shown to be very effective in a patient with late-onset severe eosinophilic asthma presenting features of chronic obstructive disease—habitual exposure to tobacco and inhaled noxious substances, and persistent airflow limitation on spirometry. Full article
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