Asthma

No need to wait for European consensus on severe eosinophilic asthma: Expert 


The European respiratory community is working towards consensus on the diagnosis and management of severe eosinophilic asthma but there’s no need to wait for them, according to an Australian expert.

Conjoint Professor Peter Wark, from the University of Newcastle’s Centre for Healthy Lungs, told the limbic the evidence was already there and targeted treatments were available.

“We can do something now because we have the option to think beyond the label of asthma and be more specific. We’re on the cusp on implementing this in practice.”

“People with this type of asthma are potentially suitable for monoclonal antibody therapy for control of their disease and we need to be thinking of this.”

He said the consensus process underway in Europe and due to report in 2018 would be effective in promoting a change in thinking about refractory asthma.

An editorial in the European Respiratory Journal by the expert taskforce outlined the proposed major criteria for severe eosinophilic asthma – a diagnosis of severe asthma, high eosinophilic disease, two or more exacerbations per year and dependence on oral corticosteroids.

Suggested minor criteria include late onset of disease, upper airway disease, a role for other biomarkers, fixed airflow obstruction and air trapping.

The taskforce said the interpretation of biomarkers such as exhaled nitric oxide fraction, serum periostin and dipeptidyl peptidase-4 (DPP-4) was one of the issues yet to be resolved.

Professor Wark said patients with refractory disease and persistent eosinophils were eligible for the interleukin-5 inhibitor mepolizumab.

“A lot of people on long term corticosteroids may well have suppressed eosinophils and as the authority for mepolizumab requires a recent blood eosinophil count ≥0.3 x109/L, there may be a need to reduce steroids in order to uncover that.”

He said people with the highest eosinophil counts tended to do best on the treatment.

“Similar to what has happened in oncology, we are paying more attention to the underlying disease process and taking a more defined endotype approach to managing airways disease.”

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