Asthma diagnosis and treatment: Filling in the information gaps

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Asthma diagnosis and treatment: Filling in the information gaps William W. Busse, MD Journal of Allergy and Clinical Immunology Volume 128, Issue 4, Pages 740-750 (October 2011) DOI: 10.1016/j.jaci.2011.08.014 Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Demographics and clinical characteristics of the SARP subjects evaluated in the cluster analysis. ∗High-dose ICS dose equivalent to 1000 fluticasone propionate daily or greater. ∗∗Chronic oral corticosteroids (CS) of 20 mg/d or greater or other systemic steroids in the past 3 months. †Controllers include leukotriene receptor antagonists, ICSs, LABAs, theophyllines, oral corticosteroids, or omalizumab. P values are from χ2 analysis of ranked ordinal composite variables. Adapted from data reported in Moore et al.8 Journal of Allergy and Clinical Immunology 2011 128, 740-750DOI: (10.1016/j.jaci.2011.08.014) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 The maximum percentage decrease in FEV1 for mannitol and methacholine in subjects in the per-protocol populations. Reproduced with permission from Anderson et al.17 Journal of Allergy and Clinical Immunology 2011 128, 740-750DOI: (10.1016/j.jaci.2011.08.014) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Cumulative exacerbations in the control (dotted line) and Feno (solid line) groups. Excerpted from Shaw et al.23 Reprinted with permission of the American Thoracic Society. Copyright © American Thoracic Society. Journal of Allergy and Clinical Immunology 2011 128, 740-750DOI: (10.1016/j.jaci.2011.08.014) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 Relative expression of 3 genes induced by IL-13. Relative expression levels (normalized fluorescence units) of periostin (POSTN), chloride channel regulator 1 (CLCA1), and serpin peptidase inhibitor, clade B, member 2 (SERPINB2) in healthy control subjects (n = 28) and patients with asthma (n = 42). Reproduced from Woodruff et al.33 Reprinted with permission of the American Thoracic Society. Copyright © American Thoracic Society. Journal of Allergy and Clinical Immunology 2011 128, 740-750DOI: (10.1016/j.jaci.2011.08.014) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 5 Responsiveness of patients with TH2-high asthma to inhaled steroids. FEV1 was measured at baseline (week 0), after 4 and 8 weeks of daily fluticasone (500 mg twice daily), and 1 week after the cessation of fluticasone (week 9). There was no significant change in FEV1 in response to placebo at any time point in either group. Reproduced from Woodruff et al.33 Reprinted with permission of the American Thoracic Society. Copyright © American Thoracic Society. Journal of Allergy and Clinical Immunology 2011 128, 740-750DOI: (10.1016/j.jaci.2011.08.014) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 6 Stepwise approach for managing asthma in youths older than 12 years and adults. Excerpted from the National Asthma Education and Prevention Program’s “Expert panel report 3: Guidelines for the diagnosis and management of asthma.”2 LTRA, Leukotriene receptor antagonist; SABA, short-acting β-agonist. Journal of Allergy and Clinical Immunology 2011 128, 740-750DOI: (10.1016/j.jaci.2011.08.014) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 7 The cycle of asthma hospitalization of children aged 5 to 15 years from April 1990 to March 2003 as multiples of the weekly mean number of hospitalizations over the whole period. Excerpted with permission from Johnston et al.61 Journal of Allergy and Clinical Immunology 2011 128, 740-750DOI: (10.1016/j.jaci.2011.08.014) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 8 Seasonal variation in days with symptoms, frequency of exacerbations, and dose of inhaled glucocorticoids in patients treated with omalizumab (orange) versus placebo (blue). Reproduced with permission from Busse et al.56 Journal of Allergy and Clinical Immunology 2011 128, 740-750DOI: (10.1016/j.jaci.2011.08.014) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Journal of Allergy and Clinical Immunology 2011 128, 740-750DOI: (10 Journal of Allergy and Clinical Immunology 2011 128, 740-750DOI: (10.1016/j.jaci.2011.08.014) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions