Towards personalization of asthma treatment according to trigger factors

DOCENA GUILLERMO; KATARZYNA NIESPODZIANA; RUDOLF VALENTA; KRISTINA BOROCHOVA

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

MOSBY-ELSEVIER

Año: 2020

0091-6749

Asthma is a health problem of increasing importance, affectingmore than 300 million people worldwide.1 It is estimated thatasthma contributes to approximately 0.4 million deaths everyyear and the mortality might be even increased in high-riskpatients.2,3 The number of disability-adjusted life-years due toasthma is approximately 23 million per year, and asthma thusaccounts for approximately 1% of all disability-adjustedlife-years lost.1 A considerable proportion of the asthma burdenis attributed to acute exacerbations, which are associated withhigh morbidity and can lead to death. Acute exacerbations ofasthma are an enormous problem to both adults and children,and account for approximately 50% of asthma health care costs.4The rising prevalence of asthma and its accompanying health carecosts are therefore major health and socioeconomic concerns.5Patients suffering from asthma are often treated accordingto management strategies suggested by the Global Initiativefor Asthma (GINA), which are regularly revised.1 GINAdefines asthma as ??a heterogeneous disease usually characterizedby chronic airway inflammation with a history ofrespiratory symptoms such as wheeze, shortness of breath,chest tightness and cough that vary over time and in intensity,together with variable expiratory airflow limitations.?? GINA isuseful because it advocates management of asthma andrespiratory disease according to published ??good quality??evidence; however, suggested treatment options are limitedto few drugs with little recommendations regarding the useof new biologics and other treatment options such asallergen-specific immunotherapy.6,7Furthermore, GINA does not discriminate asthma according tothe underlying trigger factors, which most certainly contribute tothe phenotypic heterogeneity of asthma. Allergen exposure is amajor asthma trigger factor for patients suffering from IgEassociatedallergy.8,9 Likewise, viral respiratory infections,particularly those caused by rhinoviruses (RVs), representfrequent triggers for acute asthma exacerbations in allergic aswell as in nonallergic subjects.10-12Recently, new biomarkers have been developed for thediagnosis of specific IgE sensitization toward a large varietyof individual allergen molecules and for the detection of RVstrain?specific IgG antibody responses.