Biologics and airway remodeling in asthma: early, late, and potential preventive effects.

Although airway remodeling in severe and/or fatal asthma is stil considered irreversible, its individual components as a cause of clinical symptoms and/or lung function changes remain largely unknown. While inhaled glucocorticoids have not consistently been shown to affect airway remodeling, biologics targeting specific pathways of airway inflammation have been shown to improve lung function, mucus plugging, and airway structural changes that can exceed those seen with glucocorticoids. This superiority of biologic treatment, which cannot be solely explained by insufficient doses or limited durations of glucocorticoid therapies, needs to be further explored.

Bronchodilator Response in Post-COVID-19 Patients Undergoing Pulmonary Rehabilitation.

Introduction: SARS-CoV-2 infections can result in a broad spectrum of symptoms from mild to life-threatening. Long-term consequences on lung function are not well understood yet.

Methods: In our study, we have examined 134 post-COVID patients (aged 54.

Validation of the German version of the Asthma Impairment and Risk Questionnaire (AIRQ).

Background: The Asthma Impairment and Risk Questionnaire (AIRQ), a 10-item, equally weighted, yes/no tool assessing symptom impairment and risk of exacerbations in patients with asthma aged ≥12 years, was developed and validated in a US patient population to evaluate varying levels of asthma control. This study aimed to validate the German language version of the AIRQ in patients aged ≥12 years with different levels of asthma control.

Methods: A cross-sectional, observational, multi-centre study comprising a single visit was conducted in multiple specialised asthma centres and general practices in Germany.

[Modern asthma management].

Symptom prevention and remission are the goals of asthma treatment. Precise phenotyping of the patients, including history, lung function, allergology and measurement of type 2 biomarkers, is the essential prerequisite for treatment success. Basic measures, treatment with DMAADs ("disease-modifying anti-asthmatic drugs": predominantly inhaled corticosteroids, biologics, and allergen immunotherapy) and treatment of comorbidities are the cornerstones of modern asthma management.

Flow Cytometry as an Alternative to Microscopy for the Differentiation of BAL Fluid Leukocytes.

Background: Microscopy is currently the gold standard to differentiate BAL fluid (BALF) leukocytes. However, local expertise for microscopic BALF leukocyte differentiation is often unavailable in clinical practice.

Research Question: Can automated flow cytometry be used instead of microscopy to differentiate BALF leukocytes?

Study Design And Methods: A new automated flow cytometric method for BALF leukocyte differentiation, using four antibodies (anti-CD45, anti-CD66b, anti-HLA-DR, anti-CD52) given to human BALF in one tube, was developed and prospectively validated in 745 unselected subsequent BALF samples from patients with interstitial lung diseases (455 patients), infectious diseases (196 patients), and other diseases (94 patients).

Remission in asthma.

Purpose Of Review: To review the current concepts of remission in asthma.

Recent Findings: Until 2023, asthma guidelines have been promoting the concept of disease control, recommending the step-wise addition of drugs until the best possible disease control is achieved. With the advent of highly effective, anti-inflammatory disease-modifying antiasthmatic drugs (DMAADs), treatment goals of asthma have changed.

[Update on asthma 2024 - what the ENT specialist needs to know].

The lifetime prevalence of 8.6% of asthma in Germany reflects the high medical and socioeconomic impact of the disease. Asthma treatment goals have changed during the last decades: from symptom control to symptom prevention, with highly effective, disease-modifying anti-asthmatic drugs (DMAADs) aiming at asthma remission.

[Precision medicine in the diagnosis and treatment of asthma].

Due to the availability of disease-modifying anti-asthmatic drugs (DMAADs), especially inhaled steroids (alone or in combination with long-acting bronchodilators), biologics and modern allergen immunotherapy, the treatment of asthma has fundamentally changed. The aims of modern asthma precision medicine are prevention of symptoms and the induction and maintenance of asthma remission (long-term asthma control, freedom from exacerbations and stable lung function without the use of systemic steroids). A treat to target approach is used as for other chronic inflammatory diseases in internal medicine: the aim is to achieve remission by an individually tailored treatment with DMAADs; however, the prerequisite for modern asthma precision medicine is asthma phenotyping, including a detailed medical history, lung function testing, allergological diagnostics and measurement of type 2 markers (blood eosinophils and, if available, exhaled nitric oxide, FeNO).

Allergen immunotherapy for allergic asthma.

Remission is the goal of modern asthma treatment. Allergen immunotherapy (AIT) is an essential component in the armamentarium of personalized asthma therapy. Subcutaneous AIT (SCIT) or sublingual AIT (SLIT) offer the possibility to prevent asthma in patients with allergic rhinitis (reduction of the risk of developing asthma) and the possibility to achieve remission in patients with allergic asthma.

Asthma therapy concepts through the ages.

The development and approval of DMAADs ("disease-modifying anti-asthmatic drugs"), in particular inhaled steroids (alone or in combination with long-acting bronchodilators), biologics and modern allergen immunotherapies, has fundamentally changed the asthma therapy concept from symptom control to symptom prevention. This concept is linked to the new asthma treatment goal of asthma remission: long-term absence of symptoms (good asthma control), absence of exacerbations, and stable lung function, without the use of systemic steroids for asthma therapy. Three types of asthma remission are distinguished: spontaneous remission (e.

Advanced separation of mineral oil aromatic hydrocarbons by number of aromatic rings using donor-acceptor-complex chromatography to extend on-line coupled liquid chromatography-gas chromatography.

An automated implementation for a subfractionation of mineral oil aromatic hydrocarbons (MOAH) into a mono-/di-aromatic fraction (MDAF) and a tri-/poly-aromatic fraction (TPAF) is presented, which is highly demanded by the European Food Safety Authority (EFSA) respecting the genotoxic and carcinogenic potential of MOAH. For this, donor-acceptor-complex chromatography (DACC) was used as a selective stationary phase to extend the conventional instrumental setup for the analysis of mineral oil hydrocarbons via on-line coupled liquid chromatography-gas chromatography-flame ionization detection (LC-GC-FID). A set of six new internal standards was introduced for the verification of the MOAH fractionation and a quantification of MDAF and TPAF, respectively.

Tezepelumab in patients with allergic and eosinophilic asthma.

Asthma is a heterogeneous disease commonly driven by allergic and/or eosinophilic inflammation, both of which may be present in severe disease. Most approved biologics for severe asthma are indicated for specific phenotypes and target individual downstream type 2 components of the inflammatory cascade. Tezepelumab, a human monoclonal antibody (immunoglobulin G2λ), binds specifically to thymic stromal lymphopoietin (TSLP), an epithelial cytokine that initiates and sustains allergic and eosinophilic inflammation in asthma.

Real-World Characteristics of Patients with Severe Asthma prior to Starting Dupilumab: The ProVENT Study.

Introduction: Dupilumab is approved for the treatment of severe type 2 (T2) asthma; however, the characteristics of patients receiving dupilumab in routine clinical practice are incompletely understood. This study describes the characteristics of patients with severe asthma before dupilumab treatment in a real-world setting.

Methods: This interim analysis of an ongoing real-life study of dupilumab assessed baseline characteristics of the first patient cohort enrolled in the ProVENT study.

Response to Various Biologics in Patients with Both Asthma and Chronic Obstructive Pulmonary Disease.

Introduction: Patients can have features of both chronic obstructive pulmonary disease (COPD) and asthma. However, there is still no consensus how to precisely define this patient population. In addition, there are little data on the effectiveness of biologics in these patients.

[Diagnosis and treatment of asthma: a guideline for respiratory specialists 2023 - published by the German Respiratory Society (DGP) e. V.].

The management of asthma has fundamentally changed during the past decades. The present guideline for the diagnosis and treatment of asthma was developed for respiratory specialists who need detailed and evidence-based information on the new diagnostic and therapeutic options in asthma. The guideline shows the new role of biomarkers, especially blood eosinophils and fractional exhaled NO (FeNO), in diagnostic algorithms of asthma.

Response to Biologics and Clinical Remission in the Adult German Asthma Net Severe Asthma Registry Cohort.

Background: Recently, criteria for evaluation of response to biologics have been proposed and the concept of clinical remission has gained attention as a possible goal even in severe asthma.

Objective: To analyze the response and remission in the German Asthma Net severe asthma registry cohort.

Methods: We included adults not using a biologic at baseline (V0) and compared patients treated between V0 and 1-year visit (V1) without using a biologic (group A) to patients starting with a biologic after V0 and continuing it up to V1 (group B).