Asthma end points and outcomes: What have we learned?

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Presentation transcript:

Asthma end points and outcomes: What have we learned? Don Bukstein, MD, Monica Kraft, MD, Andrew H. Liu, MD, FAAAAI, Stephen P. Peters, MD, PhD, FAAAAI Journal of Allergy and Clinical Immunology Volume 118, Issue 4, Pages S1-S15 (October 2006) DOI: 10.1016/j.jaci.2006.08.002 Copyright © 2006 American Academy of Allergy, Asthma and Immunology Terms and Conditions

Fig 1 In a comparison of 2 groups of patients with asthma, there were significant increases in both closing volume (CV; P = .024) and closing capacity (CC; P = .030) in those with difficult-to-control asthma over those with stable asthma, highlighting the role of these measures of small airway function. No significant difference in FEV1, total lung capacity (TLC), FRC, or RV was noted between the 2 groups. Adapted with permission from in't Veen JC, Beekman AJ, Bel EH, Sterk PJ. Recurrent exacerbations in severe asthma are associated with enhanced airway closure during stable episodes. Am J Respir Crit Care Med 2000;161:1902-6.10 Journal of Allergy and Clinical Immunology 2006 118, S1-S15DOI: (10.1016/j.jaci.2006.08.002) Copyright © 2006 American Academy of Allergy, Asthma and Immunology Terms and Conditions

Fig 2 Bronchial biopsy specimens from patients with newly diagnosed asthma showed significantly increased numbers of eosinophils, lymphocytes, macrophages, and plasma cells (all P < .001) in the lamina propria. Reprinted with permission from Laitinen LA, Laitinen A, Haahtela T. Airway mucosal inflammation even in patients with newly diagnosed asthma. Am Rev Respir Dis 1993;147:697-704.13 Journal of Allergy and Clinical Immunology 2006 118, S1-S15DOI: (10.1016/j.jaci.2006.08.002) Copyright © 2006 American Academy of Allergy, Asthma and Immunology Terms and Conditions

Fig 3 Although asthma is routinely classified as intermittent, mild, moderate, or severe, the severity of asthma changes over time. Journal of Allergy and Clinical Immunology 2006 118, S1-S15DOI: (10.1016/j.jaci.2006.08.002) Copyright © 2006 American Academy of Allergy, Asthma and Immunology Terms and Conditions

Fig 4 The Asthma Control Test is a quick and helpful 5-question test, which takes less than 30 seconds to complete after the patient has experience with it. Reprinted with permission from QualityMetric, Providence, RI. Journal of Allergy and Clinical Immunology 2006 118, S1-S15DOI: (10.1016/j.jaci.2006.08.002) Copyright © 2006 American Academy of Allergy, Asthma and Immunology Terms and Conditions

Fig 5 A, eNO and sputum eosinophil measurement for asthma in adults: receiver operating characteristic curves. Sputum eosinophil and eNO values correlated with each other and provided diagnostic accuracy. Levels of greater than 20 ppb for eNO and greater than 3% for sputum eosinophils were found to be highly predictive of asthma. B, Peak flows and spirometry for asthma in adults: receiver operating characteristic curves. Conventional tests were found to be poorly sensitive (0% to 47%) in comparison with sputum eosinophil and eNO measurement. Reprinted with permission from Smith AD, Cowan JO, Filsell S, McLachlan C, Monti-Sheehan G, Jackson P, et al. Diagnosing asthma: comparisons between exhaled nitric oxide measurements and conventional tests. Am J Respir Crit Care Med 2004;169:473-8.54 Journal of Allergy and Clinical Immunology 2006 118, S1-S15DOI: (10.1016/j.jaci.2006.08.002) Copyright © 2006 American Academy of Allergy, Asthma and Immunology Terms and Conditions