Tuberc Respir Dis.  2010 Dec;69(6):411-417.

Asthma Year in Review

• Kim SH

Abstract

This review highlights articles pertaining to the following 5 topics: the relationship between asthma, allergic and non-allergic rhinitis; the novel asthma phenotypes using cluster analysis; the diagnostic properties of inhaled dry-powder mannitol for the diagnosis of asthma; the value of mepolizumab therapy in exacerbations of refractory eosinophilic asthma; the role of bronchial thermoplasty in the treatment of severe asthma.

Keyword

Asthma; Rhinitis; Cluster analysis; Mannitol; mepolizumab

MeSH Terms

Antibodies, Monoclonal, Humanized
Asthma
Cluster Analysis
Eosinophils
Mannitol
Phenotype
Rhinitis
Antibodies, Monoclonal, Humanized
Mannitol

Figure

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  Figure 1 Reduction of the original 628 variables in the SARP database. The 17 composite variables from the questionnaire data incorporate answers from 63 individual questions. The 34 final variables in the cluster analysis include 23 variables from the questionnaire data, 6 related to lung function and 5 markers of atopy. Following the cluster analysis, stepwise discriminant analysis identified 11 significant predictors of cluster assignment. Three of these variables (Baseline and Maximal FEV1 % predicted, age of disease onset) were used in the Tree analysis.

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  Figure 2 Tree analysis. Using three variables (baseline FEV1 [with a bronchodilator withhold], maximal "Max" FEV1 after six to eight puffs of albuterol, and age of onset of asthma), subjects can be assigned to the five clusters that range from milder asthma (Cluster 1) to more severe disease (Clusters 4 and 5).

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  Figure 3 Severe exacerbations during the course of the study. (A) shows the cumulative number of severe exacerbations that occurred in each study group over the course of 50 weeks. (B) shows the distribution of the number of exacerbations among subjects in each study group during the treatment period of the study. The mean number of exacerbations per subject over the course of the 50-week treatment period was 2.0 in the mepolizumab group, as compared with 3.4 in the placebo group (relative risk, 0.57; 95% confidence interval, 0.32 to 0.92; p=0.02).

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  Figure 4 Change in asthma quality of life by treatment group. (A) Change in AQLQ score over 12 months after treatment with BT (diamonds) or sham control (squares) in the per protocol population. (B) Percentage of subjects achieving an AQLQ score change of 0.5 or greater (the minimal important difference), -0.05 to less than 0.5, and 20.5 after treatment with BT (black) or sham control (white) in the per protocol population. *Posterior probability of superiority 5 97.9%, †Posterior probability of superiority 5 100.0% for "Net" benefit ([proportion improving-proportion deteriorating in the BT group]-[proportion improving-proportion deteriorating in the sham group]). BT: bronchial thermoplasty; AQL: asthma quality of life questionnaire.

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  Figure 5 Healthcare utilization events during the post-treatment period. Severe exacerbations (exacerbation requiring treatment with systemic corticosteroids or doubling of the inhaled corticosteroids dose), emergency department visits, and hospitalizations occurring in the post-treatment period. Open bars, sham; shaded bars, bronchial thermoplasty. All values are means 6 SEM. *Posterior probability of superiority 5 95.5%, †Posterior probability of superiority 5 99.9%.

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