Publications by authors named "Kurukulaaratchy R"

Background: Adverse food reactions include food allergy (FA; immune-mediated) and food intolerances (non-immune-mediated). FA are classified into IgE- and non-IgE-mediated FA. There is limited information available about changes in FA prevalence over time.

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While the phenotypic diversity of childhood wheezing is well described, the subsequent life course of such phenotypes and their adult outcomes remain poorly understood. We hypothesized that different childhood wheezing phenotypes have varying longitudinal outcomes at age 26. We sought to identify factors associated with wheezing persistence, clinical remission, and new onset in adulthood.

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  • - The development of the CompOsite iNdexes For Response in asthMa (CONFiRM) aimed to create patient-centered tools that measure responses to biologics for severe asthma in both adults and children, integrating clinical data and quality of life (QoL) indicators.
  • - Experts and patients collaborated to identify significant outcome changes and devised CONFiRM scores, which demonstrated high levels of agreement on key factors, with patients emphasizing the importance of quality of life more than healthcare professionals did.
  • - The CONFiRM scores effectively measure treatment response, with strong validity metrics indicating their reliability, and they facilitate a comprehensive assessment of biologics’ effectiveness; further studies are required for prospective validation.
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  • Difficult-to-treat asthma is hard to control even with strong medicine and is linked to breathing pattern issues (BPD) in many patients.
  • The review looks at how BPD affects people with this type of asthma and suggests teamwork among doctors and specialists to provide the best care.
  • More research is needed to improve how we diagnose and treat both difficult-to-treat asthma and related breathing problems so that patients can feel better overall.
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The anti-IgE monoclonal antibody omalizumab is widely used for severe asthma. This study aimed to identify biomarkers that predict clinical improvement during 1 year of omalizumab treatment. One-year open-label Study of Mechanisms of action of Omalizumab in Severe Asthma (SoMOSA) involving 216 patients with severe (Global Initiative for Asthma step 4/5) uncontrolled atopic asthma (at least two severe exacerbations in the previous year) taking high-dose inhaled corticosteroids and long-acting β-agonists with or without maintenance oral corticosteroids.

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Background: Despite most of the asthma population having mild disease, the mild asthma phenotype is poorly understood. Here, we aim to address this gap in knowledge by extensively characterising the mild asthma phenotype and comparing this with difficult-to-treat asthma.

Methods: We assessed two real-world adult cohorts from the South of England using an identical methodology: the Wessex AsThma CoHort of difficult asthma (WATCH) (n=498) and a mild asthma cohort from the comparator arm of the Epigenetics Of Severe Asthma (EOSA) study (n=67).

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Background: Breathing pattern disorder (BPD) reflects altered biomechanical patterns of breathing that drive breathing difficulty and commonly accompanies difficult-to-treat asthma. Diagnosis of BPD has no gold standard, but Nijmegen Questionnaire (NQ) >23 is commonly used.

Objectives: We sought to advance clinical characterization of BPD and better understand the clinical utility of NQ in difficult asthma in patients from the Wessex AsThma CoHort of difficult asthma (WATCH) study.

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  • Vaccination is essential for controlling COVID-19, but hesitancy is a challenge, especially among patients with severe asthma; this study explores their vaccination experiences.
  • A questionnaire was distributed to patients with severe asthma across 12 European countries, revealing that 88% of participants had been or planned to be vaccinated, while 9.5% hesitated and 3% refused; beliefs about vaccines influenced these decisions.
  • Most patients reported mild or no side effects and noted minimal impact on asthma symptoms post-vaccination, with nearly all vaccinated individuals recommending the vaccine to others in their situation.
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Background: Patients with severe uncontrolled asthma represent a distinct endotype with persistent airway inflammation and remodeling that is refractory to corticosteroid treatment. CD4 T2 cells play a central role in orchestrating asthma pathogenesis, and biologic therapies targeting their cytokine pathways have had promising outcomes. However, not all patients respond well to such treatment, and their effects are not always durable nor reverse airway remodeling.

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Background: Numerous risk scores have been developed to predict childhood asthma. However, they may not predict asthma beyond childhood. We aim to create childhood risk scores that predict development and persistence of asthma up to young adult life.

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Background: Clustering techniques can define the heterogeneity of asthma and wheezing. Defining early-life wheezing clusters and associated asthma risk could potentially inform patient management strategies. Clustering models that yield replicable cluster groups will have greater validity and clinical utility.

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Background: Asthma is conventionally stratified as type 2 inflammation (T2)-high or T2-low disease. Identifying T2 status has therapeutic implications for patient management, but a real-world understanding of this T2 paradigm in difficult-to-treat and severe asthma remains limited.

Objectives: To identify the prevalence of T2-high status in difficult-to-treat asthma patients using a multicomponent definition and compare clinical and pathophysiologic characteristics between patients classified as T2-high and T2-low.

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Objective: Combination biological therapies are being considered increasingly for patients with multiple co-morbidities requiring biologics. There are limited data available on this approach, and concerns remain about the possible risk of adverse events, particularly infection.

Methods: We present three patients on dual biologics for rheumatic disease and asthma.

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The measurement of exhaled volatile organic compounds (VOCs) in exhaled breath (breathomics) represents an exciting biomarker matrix for airways disease, with early research indicating a sensitivity to airway inflammation. One of the key aspects to analytical validity for any clinical biomarker is an understanding of the short-term repeatability of measures. We collected exhaled breath samples on 5 consecutive days in 14 subjects with severe asthma who had undergone extensive clinical characterisation.

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Background: Air pollution is associated with poor asthma outcomes. High-efficiency particulate air air purifiers may reduce air pollution and thus improve asthma outcomes. However, the efficacy of such devices for this purpose remains inconclusive.

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Three to ten percent of people living with asthma have difficult-to-treat asthma that remains poorly controlled despite maximum levels of guideline-based pharmacotherapy. This may result from a combination of multiple adverse health issues including aggravating comorbidities, inadequate treatment, suboptimal inhaler technique and/or poor adherence that may individually or collectively contribute to poor asthma control. Many of these are potentially "treatable traits" that can be pulmonary, extrapulmonary, behavioural or environmental factors.

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Difficult asthma describes asthma in which comorbidities, inadequate treatment, suboptimal inhaler technique and/or poor adherence impede good asthma control. The association of anxiety and depression with difficult asthma outcomes (exacerbations, hospital admissions, asthma control, etc.) is unclear.

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Article Synopsis
  • - The COVID-19 pandemic prompted healthcare providers in Europe to adapt severe asthma care, with significant shifts towards video/phone consultations and home-administered biologics.
  • - A study surveyed 1101 patients and 268 physicians, revealing that 79% of patients were satisfied with remote consultations, while 62% were satisfied with home-administered biologics.
  • - Many physicians anticipate these changes will persist post-pandemic, although the long-term satisfaction of patients may vary as care evolves.
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