Severe Asthma Endotypes: A Test on Features, Assessment & Treatment

February 8, 2022

How familiar are you with mechanistic features of severe asthma, specific biomarker level cut offs, and impact of comorbid disease on choice of biologic treatment?

Consideration of the specific mechanistic pathway that underlies a presentation of severe asthma is one key factor in choosing the appropriate biologic treatment as are investigation of biomarker levels and evaluation of comorbid inflammatory disease.

Following are 5 questions on these topics that are based on a comprehensive review and international expert opinion published this month in the Journal of Allergy and Clinical Immunology: In Practice by a group of experts recognized for knoweldge of severe asthma and of biologic medications.

Test your endotype IQ!

1. True or false? Fraction of exhaled nitric oxide (FeNO) levels have demonstrated both prognostic and predictive value for patients with severe asthma.

Answer: True. A combination of blood eosinophil count (BEC) and FeNO levels provides additive information for biologic medications.

2. Before a biologic medication is initiated for severe asthma, a 4-phase baseline assessment is recommended to accomplish which of the following?

Answer: Global Initiative for Asthma and European Academy of Allergy and Clinical Immunology recommendations state that biologic therapy can be used in patients with severe asthma who show typical biomarkers of T2 airway inflammation.

3. True or false? There is strong evidence to support biologic efficacy for patients with persistently low BEC (<150 cells/μL) and FeNO levels who are not receiving systemic corticosteroids.

Answer: False - There is no evidence to support biologic efficacy for patients with persistently low BEC (<150 cells/μL) and FeNO levels who are not receiving systemic corticosteroids.

4. What is recommended as the first choice for the treatment of patients with BEC ≥150 to ≤1500 cells/μL and severe atopic dermatitis?

CRSwNP, chronic rhinosinusitis with nasal polyps

Answer: Anti-IL-4/13 is recommended as the first choice for the treatment of patients with BEC ≥150 to ≤1500 cells/μL and severe atopic dermatitis.

5. True or false? For patients with BEC >1500 cells/μL, potential reasons why BEC is elevated to this level should be determined before a treatment decision is made.

Answer: True. For patients with BEC >1500 cells/μL, potential reasons why BEC is elevated to this level should be determined before a treatment decision is made. These could include hematologic conditions and other hypereosinophilic conditions (eg, parasite infection, eosinophilic granulomatosis with polyangiitis, and allergic bronchopulmonary aspergillosis).