Real-Life Response to Biologics in Severe Asthma with Nasal Polyposis: Insights from the Belgian Severe Asthma Registry.

Background: Nasal polyposis (NP) is a comorbidity of type 2 severe asthma (SA) which could influence response to SA biologics.

Methods: We evaluated (super-) response in SA patients with (NP +) and without NP (NP-) enrolled in the Belgian Severe Asthma Registry (BSAR).

Results: 914 patients, of whom 31% NP + , were included.

The Impact of Airway Obstruction on Feno Values in Asthma Patients.

Background: Exhaled nitric oxide (Feno) is used as a marker of type-2 airway inflammation in asthma management. Studies with airway challenges demonstrated that a reduction in airway caliber decreases Feno levels.

Objective: To evaluate the impact of airway caliber reduction occurring spontaneously in patients with asthma on Feno values in daily clinical practice.

Anti-Interleukin-5 Therapy Is Associated with Attenuated Lung Function Decline in Severe Eosinophilic Asthma Patients From the Belgian Severe Asthma Registry.

Background: Asthmatics have accelerated lung function decline over time compared with healthy individuals.

Objective: To evaluate risk factors for accelerated lung function decline.

Methods: In a longitudinal analysis on severe asthmatics enrolled in the Belgian Severe Asthma Registry with at least 2 visits a minimum of 12 months apart, we compared characteristics of patients with and without decline (loss of post-bronchodilation forced expiratory volume in 1 s [FEV] (% predicted)/y greater than zero) over time.

Closing volume detection by single-breath gas washout and forced oscillation technique.

Closing volume (CV) is commonly measured by single-breath nitrogen washout (CV). A method based on the forced oscillation technique was recently introduced to detect a surrogate CV (CV). As the two approaches are based on different physiological mechanisms, we aim to investigate CV and CV relationship at different degrees and patterns of airway obstruction.

Exploring the sites and kinetics of bronchodilator response to -2 agonists in asthma.

We previously documented, in patients with asthma, three different profiles of bronchodilation induced by short-acting β-2 mimetics (SABA), characterized by dilation up to central, preacinar, and intra-acinar airways assessed by ventilation distribution tests and associated with no change, increase, and decrease of fractional exhaled nitric oxide concentration (FENO), respectively. To investigate the dynamics of these profiles over the entire SABA action period, assuming that bronchodilation of proximal and peripheral airways could exhibit varying kinetics due to differences in the distribution of β-2 receptors in both the central and peripheral human airways. FENO, forced expired volume in one second (FEV), and the slope () of He and SF phase III (single-breath test) were measured in asthma patients before, and up to 6 h after SABA inhalation (salbutamol 400 µg).

COVID-19 and biologics in severe asthma: data from the Belgian Severe Asthma Registry.

https://bit.ly/3ndZmyD

An Emerging Role for Exhaled Nitric Oxide in Guiding Biological Treatment in Severe Asthma.

Asthma is a heterogeneous disease with regard to the inflammatory pathways activated. In recent years, biologic drugs (monoclonal antibodies) directed towards specific components of type 2 inflammation have been approved for the treatment of severe asthma. Phenotyping of patients with severe asthma and evaluation of biomarkers have been recommended to help identify patients who are candidates for treatment with biologics and to monitor treatment responses.

Severe asthma: oral corticosteroid alternatives and the need for optimal referral pathways.

Objective: Patients with severe asthma require high-dose inhaled corticosteroids, with or without add-on treatments, to maintain asthma control. Because symptom control remains unsatisfactory in some patients despite these therapies, maintenance therapy with oral corticosteroids (OCS) remains considered a treatment option by physicians. Besides physician-diagnosed exacerbations, many patients intermittently self-medicate with OCS during episodes of worsening symptoms or as a prevention of such episodes.

Variability in total serum IgE over 1 year in severe asthmatics.

Background: Immunoglobulin E (IgE) is the treatment target of omalizumab, a monoclonal antibody indicated in the treatment of severe allergic asthma. Long-term variability of serum total IgE (sIgE) in asthmatics remains poorly documented.

Methods: In this prospective study, sIgE levels were measured over 1 year at 7 time points in 41 severe asthmatics treated with high-dose of inhaled corticosteroids and long-acting β agonists.

COPD patients with peripheral airway obstruction reversibility identified by exhaled nitric oxide.

Rationale: Besides its role as an inflammatory marker in asthma, fractional exhaled nitric oxide (FNO) provides information on the extent of the airway obstruction process through evaluating its change after bronchodilation.

Objective: To investigate whether FNO change after bronchodilation can identify different sites of airway obstruction in COPD patients.

Methods: FNO, FEV and the slopes (S) of the alveolar plateau of the single breath washout test (SBWT) were measured in 61 stable COPD patients (FEV 34.

Small airways dysfunction: the link between allergic rhinitis and allergic asthma.

Abnormal airway reactivity and overproduction of nitric oxide (NO) occurring in small airways have been found in asthma. If the "one airway, one disease" concept is consistent, such dysfunctions should also be detected in the peripheral airways of patients suffering from allergic rhinitis.We investigated whether peripheral airway reactivity and NO overproduction could be documented in distal airways in patients with allergic rhinitis.

Airway calibre variation is a major determinant of exhaled nitric oxide's ability to capture asthma control.

Changes in airway calibre have the potential to modify exhaled nitric oxide fraction () values and could hamper how captures changes in asthma control. Here, our objective was to assess whether forced expiratory volume in 1 s (FEV) variations alter the ability of to reflect asthma control., asthma control (Asthma Control Questionnaire (ACQ)) and FEV were measured at least two times in 527 patients during 1819 pairs of visits.

A Belgian survey on the diagnosis of asthma-COPD overlap syndrome.

Introduction: Patients with chronic airway disease may present features of both asthma and COPD, commonly referred to as asthma-COPD overlap syndrome (ACOS). Recommendations on their diagnosis are diffuse and inconsistent. This survey aimed to identify consensus on criteria for diagnosing ACOS.

Different patterns of exhaled nitric oxide response to β2-agonists in asthmatic patients according to the site of bronchodilation.

Background: In asthmatic patients undergoing airway challenge, fraction of exhaled nitric oxide (FENO) levels decrease after bronchoconstriction. In contrast, model simulations have predicted both decreased and increased FENO levels after bronchodilation, depending on the site of airway obstruction relief.

Objective: We sought to investigate whether β2-agonists might induce divergent effects on FENO values in asthmatic patients as a result of airway obstruction relief occurring at different lung depths.

FeNO as a predictor of asthma control improvement after starting inhaled steroid treatment.

Introduction: The fraction of NO in exhaled air (FeNO) is a marker of inflammation in asthma. The aim of the present study was to assess, in a real-world setting, whether only high (⩾50 ppb) FeNO levels predict improvement in asthma control when being treated with inhaled corticosteroids (ICS), as suggested by current guidelines on the clinical use of FeNO.

Methods: FeNO and asthma control were assessed in a retrospective observational study in 153 non-smoking, steroid-naïve, adult subjects with asthma with a mean age of 40 years both before and after 6 weeks (median follow-up time) of treatment with 500 μg beclomethasone (median).

Exhaled nitric oxide: a biomarker integrating both lung function and airway inflammation changes.

Background: The increased fraction of exhaled nitric oxide (Feno) values observed in asthmatic patients are thought to reflect increased airway inflammation. However, Feno values can be affected by airway caliber reduction, representing a bias when using Feno values to assess asthma control.

Objective: We sought to determine the effect of changes in both airway caliber and inflammation on Feno values using the allergen challenge model.

Axial distribution of nitric oxide airway production in asthma patients.

In healthy subjects, axial distribution of nitric oxide (NO) airway production is likely heterogeneous: notably a distal peak of production in terminal bronchioles and a quasi-nil NO production in the most of the conducting airways. In asthma, few information exists about the contributions of the proximal and distal airways to NO overproduction. In 18 asthma patients, sites of constriction after methacholine and adenosine 5'-monophosphate (AMP) challenges were assessed by ventilation distribution tests with He and SF(6).