Download Free Medical Asthma Phenotypes PowerPoint Presentation

Asthma Phenotypes PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : This medical presentation titled ""Asthma Phenotypes"" evaluates the concept that asthma is not a single disease, identifies asthma phenotypes, and talks about a treatment approach based on the different phenotypes of asthma.

Tags : Allergy, Asthma, Phenotypes, treatment, Tightening, Airways, Airway Remodeling, Thick Mucous Production, Acute, Chronic Phases, Wheezing, Coughing, Shortness of Breath, syndrome, Eosinophils, Radioallergosorbant IgE, RAST, allergy testing, Occupational, Asthma-Exacerbated, Severe, refractory

Published on : Apr 24, 2021 | Views : 1910 | Downloads : 23

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Asthma Phenotypes Neeta Thakur MD, MPH and George Su MD Zuckerberg San Francisco General University of California, San Francisco
Slide 2-

Disclosures Spouse employee of Roche/Genentech
Slide 3-

Learning Objectives Evaluate the concept that asthma is not a single disease Identify asthma phenotypes Develop a treatment approach based on the different phenotypes of asthma
Slide 4-

Living with asthma https://lindseykonkel.files.wordpress.com/2012/10/the-racial-discrimination-embedded-in-modern-medicine.pdf Photo Credit: Sam Oh
Slide 5-

What is asthma? Tightening of Airways Airway Remodeling Thick Mucous Production Acute and Chronic Phases Wheezing Coughing Shortness of Breath What causes asthma?
Slide 6-

Lötvall JACI 2011
Slide 7-

Asthma Phenotypes Fahy Nat Rev Immunol 2015 ALLERGIC Non-ALLERGIC
Slide 8-

curr opin allergy clin immunol. 2012 apr;12(2):193-201. doi: 10.1097/aci.0b013e32835090ac. severe asthma in childhood: recent advances in phenotyping and pathogenesis.
Slide 9-

Non-eosinophilic Childhood Adult Eosinophilic Asthma Phenotypes
Slide 10-

Dust mites Pollens Eosinophils Elevated in bronchial bx, induced sputum or peripheral blood Corticosteroid naïve ≥2.7% (blood) I: concordance between symptoms and airway eos “Childhood-onset” and allergy to airborne allergens II: discordance, fewer symptoms “Late-onset” non-atopic disease Persistence on high-dose ICS or PO steroids associated with symptomatic and exacerbation-prone disease
Slide 11-

Non-eosinophilic Childhood Adult Eosinophilic Asthma Phenotypes Allergic Intrinsic
Slide 12-

Dust mites Pollens How do you identify this group? Total IgE Sum of total IgE Sometimes reported as %total IgG (0.05% normal) 60% of allergic asthma (includes HMW OA) Poor PPV and NPV compared to allergen-specific IgE
Slide 13-

Dust mites Pollens How do you identify this group? Radioallergosorbant IgE (RAST) Allergen-specific IgE More expensive than skin-prick Less sensitive and specific Rational starting point: Specific HMW candidate antigen(s) (some LMW antigens) Determine positive aeroallergen Grasses, weeds, dust mites, molds Low predictive value for food allergies
Slide 14-

Dust mites Pollens How do you identify this group? Skin prick allergy testing More sensitive and specific than RAST False negatives: OTC antihistamines (48 hours) Allegra, Clarinex, Zyrtec and Astelin (Azelastin) nasal spray (5 days) PO steroids (25 mg prednisone) (3 weeks) High dose topical steroids (3 weeks)
Slide 15-

What’s the Asthma Phenotype? Occupational Asthma Beckett W., et al., NEJM 2000
Slide 16-

Occupational Asthma “Work-sensitized” (high MW >5000 daltons) IgE-mediated “asthma with latency” “Irritant-induced” (low MW <5000 daltons) Non IgE-mediated “asthma without latency” Irritant asthma Reactive airways dysfunction syndrome (RADS) “Low-dose RADS” “Work-exacerbated” (aggravated) > 250 workplace culprit substances Estimated 16% of all adult onset asthma Toren and Blanc 2009
Slide 17-

What do these have in common?
Slide 18-

When to do obstruction testing for Occupational Asthma? Preferably performed toward the end of a typical work week and within 24 hr of the occurrence of symptoms
Slide 19-

Active panel patients with DM Non-eosinophilic Occupational (non-sensitized) Asthma Phenotypes Childhood Allergic Intrinsic Adult Eosinophilic Occupational (sensitized)
Slide 20-

What’s the Asthma Phenotype? 34 year old man Persistent rhinitis at age 30, watery rhinorrhea Cough, wheeze Sudden acute event requiring ED visit No previous history of asthma
Slide 21-

ppt slide no 21 content not found
Slide 22-

ppt slide no 22 content not found
Slide 23-

B. Ghorayeb, MD
Slide 24-

Case: Diagnosis Exacerbation after ingestion of aspirin or other non-NSAIDs Starts with intractable nasal congestion and watery rhinorrhea Refractory to pharmacologic Treatment Progressive, may become associated with anosmia Specific IgE tests negative Nasal polyposis Total or near-total opacification of the sinus cavities (on CT) An individual with rapid onset of a severe attack with no previous insult who necessitates acute emergency care, intensive care unit admission, or endotracheal intubation
Slide 25-

Asthma-Exacerbated Asthma
Slide 26-

Aspirin-Exacerbated Asthma: diagnosis Sample oral challenge protocol Starting dose of 40.5 mg Doses given at 3 hour intervals, up to a maximum dose of 325 mg Time interval between doses can be shortened to 90 minutes unless the patient specifically reports that symptoms began within 90 minutes Protocols are carried out over one to two consecutive days Observation and spirometry
Slide 27-

Active panel patients with DM Non-eosinophilic Childhood Adult Eosinophilic Aspirin Cough variant Air pollution Asthma Phenotypes Allergic Intrinsic Occupational (sensitized) Occupational (non-sensitized) EIA Cigarette
Slide 28-

ppt slide no 28 content not found
Slide 29-

Leiria, 2014 Obese Asthma Phenotype
Slide 30-

Active panel patients with DM Non-eosinophilic Childhood Adult Eosinophilic Aspirin Cough variant Air pollution Asthma Phenotypes Allergic Intrinsic Occupational (sensitized) Occupational (non-sensitized) EIA Cigarette Obesity
Slide 31-

ppt slide no 31 content not found
Slide 32-

Active panel patients with DM Non-eosinophilic Childhood Adult Eosinophilic Aspirin Cough variant Air pollution Asthma Phenotypes Allergic Intrinsic Occupational (sensitized) Occupational (non-sensitized) EIA Cigarette Obesity Infection-related
Slide 33-

Severe/refractory asthma (ATS workshop) Continuous or near-continuous oral steroids High-dose ICS Additional daily controller Use of SABA on a near-daily basis Persistent airway obstruction FEV1 < 80% Diurnal variation in PF ≥ 25% ≥ 1 urgent care visit per year ≥3 or more steroid bursts per year Prompt deterioration with 25% reduction in steroid dose Episode of near-fatal asthma Minor (2) Major (≥1)
Slide 34-

Active panel patients with DM Non-eosinophilic Childhood Adult Eosinophilic Aspirin Cough variant Air pollution Asthma Phenotypes Allergic Intrinsic Occupational (sensitized) Occupational (non-sensitized) EIA Cigarette Obesity Infection-related Exacerbation-prone
Slide 35-

Emerging Treatment Options Based on Phenotypes TARGETED AT Th2 (ALLERGIC) ASTHMA
Slide 36-

Treatments based on Phenotypes - Omalizumab Best Candidates: High IgE Known Allergen BMI
Slide 37-

Hanania Ann Intern Med 2011, Busse NEJM 2011 Treatments based on Phenotypes - Omalizumab Asthma Exacerbations
Slide 38-

IL-5: Key cytokine in eosinophil Differentiation Recruitment Activation Survival Best Candidates: - High Eosinophils - 2 or greater exacerbations/yr - On high dose ICS Fulkerson Nature Review Drug Discovery 2013 Treatments based on Phenotypes - Mepolizumab
Slide 39-

MENSA trial (RCT), selected for high eosinophils, mod-high dose ICS Treatments based on Phenotypes - Mepolizumab Asthma Exacerbations and FEV1 at 32 Weeks. Ortega NEJM 2014 (Sponsored by Glaxo-Smith Kline)
Slide 40-

Side Effects and Adverse Reactions Omalizumab Anaphylaxis (must have epi-pen) 0.1-0.2% Can occur as late as 1 year ? Malignancy (0.5 vs. 0.2% in RCT) Longer observation trials underway Pain and arthralgia Injection site bruising/pain Mepolizumab No observed risk of anaphylaxis Muscle pain Fatigue Injection site bruising/pain
Slide 41-

In Summary ASTHMA IS COMPLEX!!! Look at multiple data points, including Age Patient specific data: BMI, occupation Triggers Disease course Biomarkers