The Importance of Asthma Research Networks to Clinical Practice

The presidential plenary lecture at the ACAAI annual meeting reviewed important findings by research networks and how they are improving diagnosis and management of asthma in children and adults.

Stanley J. Szefler, MD, of Children’s Hospital Colorado; and the University of Colorado Denver School of Medicine, reviewed a wide variety of studies: Childhood Asthma Program Research Group (CAMP), the Prevention of Early Asthma in Kids study (PEAK) study, multiple follow-up studies to CAMP and PEAK, as well as research regarding possible predictors of treatment response.

He said the key takeaways from the literature are that exhaled nitric oxide, blood eosinophils, and allergen sensitivity can be useful in selecting inhaled corticosteroids (ICS) as step 2 therapy. Race and ethnicity can be useful in selecting Step 3 therapy, he continued. And allergen sensitization and eosinophil count can be used to initiate treatment in young children with emerging asthma.

Szefler then reviewed research that may help healthcare providers prevent severe respiratory episodes in young children, including the Maintenance Versus Intermittent Inhaled Steroids in Wheezing Toddlers (MIST) Trial, Acute Intervention Management Strategies (AIMS) research, and outcomes from AsthmaNet. That body of research revealed disease monitoring tools, specifically lung function trajectories, EMR, biomarkers of allergic inflammation, and medication requirements.

He encouraged the audience to pursue research that can reveal further strategies to alter the natural history of asthma.

William W. Busse, MD, of the University of Wisconsin School of Medicine and Public Health, then reviewed findings in adult asthma. He cited research from the National Institute of Allergy and Infectious Diseases, Specialized Centers of Research (SCOR), Asthma Clinical Research Networks (ACRN), Childhood Asthma Research and Education (CARE), Severe Asthma Research Project (SARP), Inner City Asthma Consortium, AsthmaNet, and the American Lung Association Networks.

Busse noted that research in adults has revealed asthma phenotypes and clusters that are heterogenous and variable, and lung function has been found to be a discriminating but variable characteristic in asthma clusters. Severe asthma is largely characterized by airway obstruction, caused by air trapping and mucous, and is accompanied by symptom severity, reduced quality of life, and a risk for exacerbations. Busse also highlighted the importance of exacerbations due to increased morbidity and mortality, higher costs, progressive loss of lung function, and more. According to research he reviewed, omalizumab has been shown to be effective in reducing seasonal exacerbations.

Research has been moving asthma along a continuum from clinical phenotypes to molecular phenotypes, by establishing pathobiologic and genetic processes, to disease endotypes, by applying targeted treatments. Moving forward, he said, studies will focus on preventing the disease, increasing specificity, improving control, decreasing use of oral corticosteroids, reducing exacerbations, and lessening the progression of disease.