Defining the Asthma-COPD Overlap Syndrome in a COPD Cohort (Chest article)

Asthma-COPD overlap syndrome is very contradictory topic in Respiratory medicine!
Background  Asthma-COPD overlap syndrome (ACOS) has been recently described by international guidelines. A stepwise approach to diagnosis using usual features of both diseases is recommended although its clinical application is difficult.

Methods  To identify patients with ACOS, a cohort of well-characterized patients with COPD and up to 1 year of follow-up was analyzed. We evaluated the presence of specific characteristics associated with asthma in this COPD cohort, divided into major criteria (bronchodilator test > 400 mL and 15% and past medical history of asthma) and minor criteria (blood eosinophils > 5%, IgE > 100 IU/mL, or two separate bronchodilator tests > 200 mL and 12%). We defined ACOS by the presence of one major criterion or two minor criteria. Baseline characteristics, health status (COPD Assessment Test [CAT]), BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index, rate of exacerbations, and mortality up to 1 year of follow-up were compared between patients with and without criteria for ACOS.
Results  Of 831 patients with COPD included,125 (15%) fulfilled the criteria for ACOS, and 98.4% of them sustained these criteria after 1 year. Patients with ACOS were predominantly male (81.6%), with symptomatic mild to moderate disease (67%), who were receiving inhaled corticosteroids (63.2%). There were no significant differences in baseline characteristics, and only survival was worse in patients with non-ACOS COPD after 1 year of follow-up (P < .05).
Conclusions  The proposed ACOS criteria are present in 15% of a cohort of patients with COPD and these patients show better 1-year prognosis than clinically similar patients with COPD with no ACOS criteria.
Full text:
http://journal.publications.chestnet.org/article.aspx?articleid=2430458&resultClick=3

Novel concepts in airway inflammation and remodelling in asthma

New article in ERJ on Novel concepts in airway inflammation and remodelling in asthma!

The hallmark pathological features of asthma include airway eosinophilic inflammation and structural changes (remodelling) which are associated with an irreversible loss in lung function that tracks from childhood to adulthood. In parallel with changes in function, pathological abnormalities occur early, during the pre-school years, are established by school age and subsequently remain (even though symptoms may remit for periods during adulthood). Given the equal importance of inflammation and remodelling in asthma pathogenesis, there is a significant disparity in studies undertaken to investigate the contribution of each. The majority focus on the role of inflammation, and although novel therapeutics such as those targeted against T-helper cell type 2 (Th2) mediators have arisen, it is apparent that targeting inflammation alone has not allowed disease modification. 

Therefore, unless airway remodelling is addressed for future therapeutic strategies, it is unlikely that we will progress towards a cure for asthma. Having acknowledged these limitations, the focus of this review is to highlight the gaps in our current knowledge about the mechanisms underlying airway remodelling, the relationships between remodelling, inflammation and function, remodelling and clinical phenotypes, and the importance of utilising innovative and realistic pre-clinical models to uncover effective, disease-modifying therapeutic strategies.

fulltext:

http://erj.ersjournals.com/content/46/6/1796?rss=1&utm_content=buffer43f63&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer

GINA 2015: the latest iteration of a magnificent journey

Dear Friends we are happy to present you fresh analysis of The Global Initiative for Asthma (GINA) Guidelines 2015.

The Global Initiative for Asthma (GINA) represents a remarkable source document that has changed the course of asthma in most countries. The first asthma guidelines have been published in Australasia, UK and the USA. Canadian and French recommendations proposed the concept of control, and the National Asthma Education and Prevention Program Expert Panel Report initiated the concept of risk for asthma. 

However, GINA is globally considered to be the prominent asthma recommendation building on existing knowledge and providing several updates or revisions since it was introduced in 1995. GINA 2015 represents a significant advance over the previous iteration, with a more practical approach and an increased appreciation of asthma as a public health problem. Due to the expected impact of GINA 2015 it is mandatory to assess strengths and weaknesses although many of these cannot be ruled out due to the lack of information currently available.

Free full text: http://erj.ersjournals.com/content/46/3/579?ctkey=ERJtw108415

Evolving Concepts of Asthma in 2015

Dear Friends, in American Journal of Respiratory and Critical Care Medicine appeared new article on concepts of asthma!
Our understanding of asthma has evolved over time from a singular disease to a complex of various phenotypes, with varied natural histories, physiologies, and responses to treatment. Early therapies treated most patients with asthma similarly, with bronchodilators and corticosteroids, but these therapies had varying degrees of success. Similarly, despite initial studies that identified an underlying type 2 inflammation in the airways of patients with asthma, biologic therapies targeted toward these type 2 pathways were unsuccessful in all patients. These observations led to increased interest in phenotyping asthma. Clinical approaches, both biased and later unbiased/statistical approaches to large asthma patient cohorts, identified a variety of patient characteristics, but they also consistently identified the importance of age of onset of disease and the presence of eosinophils in determining clinically relevant phenotypes. These paralleled molecular approaches to phenotyping that developed an understanding that not all patients share a type 2 inflammatory pattern. Using biomarkers to select patients with type 2 inflammation, repeated trials of biologics directed toward type 2 cytokine pathways saw newfound success, confirming the importance of phenotyping in asthma. Further research is needed to clarify additional clinical and molecular phenotypes, validate predictive biomarkers, and identify new areas for possible interventions.

Read more: 
http://www.atsjournals.org/doi/abs/10.1164/rccm.201504-0763PP#.VhKqFitqqUl

The Asthma–COPD Overlap Syndrome 2015 Update

This week in NEJM was published review on asthma–COPD overlap syndrome!

Approximately 1 in 12 people worldwide are affected by asthma or chronic obstructive pulmonary disease (COPD); once regarded as two distinct disease entities, these two conditions are now recognized as heterogeneous and often overlapping conditions. The term “asthma–COPD overlap syndrome” (ACOS) has been applied to the condition in which a person has clinical features of both asthma and COPD.

Full text for free download:

http://www.nejm.org/doi/full/10.1056/NEJMra1411863

2015 World Allergy Organization Statement: Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders

We are happy to present you interesting 2015 World Allergy Organization Statement on Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders!

The prevalence of allergic airway diseases such as asthma and rhinitis has increased dramatically to epidemic proportions worldwide. Besides air pollution from industry derived emissions and motor vehicles, the rising trend can only be explained by gross changes in the environments where we live. The world economy has been transformed over the last 25 years with developing countries being at the core of these changes. Around the planet, in both developed and developing countries, environments are undergoing profound changes. Many of these changes are considered to have negative effects on respiratory health and to enhance the frequency and severity of respiratory diseases such as asthma in the general population. 

Increased concentrations of greenhouse gases, and especially carbon dioxide (CO ₂), in the atmosphere have already warmed the planet substantially, causing more severe and prolonged heat waves, variability in temperature, increased air pollution, forest fires, droughts, and floods – all of which can put the respiratory health of the public at risk. These changes in climate and air quality have a measurable impact not only on the morbidity but also the mortality of patients with asthma and other respiratory diseases. The massive increase in emissions of air pollutants due to economic and industrial growth in the last century has made air quality an environmental problem of the first order in a large number of regions of the world. A body of evidence suggests that major changes to our world are occurring and involve the atmosphere and its associated climate. These changes, including global warming induced by human activity, have an impact on the biosphere, biodiversity, and the human environment. Mitigating this huge health impact and reversing the effects of these changes are major challenges.

This statement of the World Allergy Organization (WAO) raises the importance of this health hazard and highlights the facts on climate-related health impacts, including: deaths and acute morbidity due to heat waves and extreme meteorological events; increased frequency of acute cardio-respiratory events due to higher concentrations of ground level ozone; changes in the frequency of respiratory diseases due to trans-boundary particle pollution; altered spatial and temporal distribution of allergens (pollens, molds, and mites); and some infectious disease vectors. According to this report, these impacts will not only affect those with current asthma but also increase the incidence and prevalence of allergic respiratory conditions and of asthma. The effects of climate change on respiratory allergy are still not well defined, and more studies addressing this topic are needed. Global warming is expected to affect the start, duration, and intensity of the pollen season on the one hand, and the rate of asthma exacerbations due to air pollution, respiratory infections, and/or cold air inhalation, and other conditions on the other hand. 

Free Full Text:

http://www.waojournal.org/content/8/1/25

New Global Initiative for Asthma 2015 strategy: a roadmap to asthma control

Today was published in ERJ: A summary of the new GINA strategy: a roadmap to asthma control!

Over the past 20 years, the Global Initiative for Asthma (GINA) has regularly published and annually updated a global strategy for asthma management and prevention that has formed the basis for many national guidelines. However, uptake of existing guidelines is poor. A major revision of the GINA report was published in 2014, and updated in 2015, reflecting an evolving understanding of heterogeneous airways disease, a broader evidence base, increasing interest in targeted treatment, and evidence about effective implementation approaches. During development of the report, the clinical utility of recommendations and strategies for their practical implementation were considered in parallel with the scientific evidence. 

This article provides a summary of key changes in the GINA report, and their rationale. The changes include a revised asthma definition; tools for assessing symptom control and risk factors for adverse outcomes; expanded indications for inhaled corticosteroid therapy; a framework for targeted treatment based on phenotype, modifiable risk factors, patient preference, and practical issues; optimisation of medication effectiveness by addressing inhaler technique and adherence; revised recommendations about written asthma action plans; diagnosis and initial treatment of the asthma−chronic obstructive pulmonary disease overlap syndrome; diagnosis in wheezing pre-school children; and updated strategies for adaptation and implementation of GINA recommendations. 

Full text of the article:

http://erj.ersjournals.com/content/early/2015/07/23/13993003.00853-2015.full

Asthma 2015 Guidelines: The 2015 update of the Global Strategy for Asthma Management and Prevention

The 2015 update of the Global Strategy for Asthma Management and Prevention incorporates new scientific information about asthma based on a review of recent scientific literature by an international panel of experts on the GINA Science Committee. It is the first annual update of the document since a major revision was launched on World Asthma Day, May 6, 2014. This comprehensive and practical resource about one of the most common chronic lung diseases worldwide contains extensive citations from the scientific literature and forms the basis for other GINA documents and programs.

World Allergy Week 2015

#Respiratorydecade happy to present World Allergy Week 2015!

Join us during World Allergy Week 2015 and increase awareness of Airway Allergies - A Human and Economic Burden.

Today the World Allergy Organization (WAO), together with its 95 national Member Societies, has launched World Allergy Week 2015. Through April 19, a variety of educational activities and media events hosted by professional allergy societies, patient advocacy groups, and other organizations around the world will stress the importance of understanding airway allergies to improve quality of life and reduce the socio-economic burden they cause.

“Allergic rhinitis and asthma are two common airway disorders that are increasing in prevalence worldwide,” said Dr Lanny Rosenwasser, President of the World Allergy Organization. “They often coexist, and treatments can address the symptoms of both disorders; but when uncontrolled they can pose a significant burden to patient, family, and society,” he said. 

“We are fortunate to be collaborating with individuals and organizations around the world who have expertise in the diseases associated with airway allergies,” said Prof. Motohiro Ebisawa, Chairperson of World Allergy Week 2015. “Their combined efforts will help raise awareness of the main airway allergies and how to understand their causes, symptoms, and methods of control, as part of a shared goal to reduce the overall global burden of allergic disease".

World Allergy Week 2015: AIRWAY ALLERGIES The human and economic burden from Juan C. Ivancevich

Internationally known airway allergy experts will address the topic of “Airway Allergies – The Human and Economic Burden” in a symposium-style conference call today at 9:00 a.m. EDT (New York) and another live call on Wednesday 15 April at 2:00 p.m. JST (Tokyo). For anyone interested in airway allergies, the calls will offer attendees the chance to ask questions to these leading experts. Toll-free call-in numbers from a variety of countries, as well as other details about the presentations, are listed at http://www.worldallergyweek.org.