Biomarkers for asthma and picking the perfect biologic
Hopefully it has finally cooled off (but not started snowing) where you live. October is a transition month as many of us will see an increasing amount of asthma patients in our practices during these fall and winter months. The complexity of asthma patients has steadily increased in the years I have been practicing. Some wonder if the disease is different now than it was 30 years ago or whether we are just more skilled at understanding the spectrum of disease. Two review articles in this month’s Annals of Allergy, Asthma and Immunology can help shed some light on this conundrum.
The first is a review by Tara Carr, MD, and Monica Kraft, MD, from Tucson, who review the potential uses for biomarkers to identify phenotypes and endotypes of asthma - particularly patients with severe disease. The classifications, based primarily on the variously described inflammatory mechanisms can be challenging to identify in individual patients. The use of biomarkers is discussed and their applications for classification as well as prognosis and/or response to therapy is outlined in a fashion that has future potential clinical utility. Of note, they do an excellent job of also describing what biomarkers cannot do because of test limitations and variability. This is an important read for those of us who care for these patients to optimize our thought processes for patient care.
Another important article that is a must-read is written by Laurie Manka, MD, and Michael Wechsler, MD, MMSc, from Denver, who address the complex issue of deciding which biological agent is most appropriate for which patient with severe asthma. The authors discuss their approach to identifying the most appropriate biologic for a patient including phenotype, endotype and specific biomarker results (where available). They also discuss selecting biologics through more traditional measures including lung function, exacerbation rates and quality of life measures, all components of what we consider defining asthma control. This paper is thought-provoking in providing a framework for developing decision strategies for the use of biologics in severe asthma.
As always, we look forward to comments about the contents of each issue. Tell us what you do – and don’t – like about it. We do take comments seriously and give consideration to feedback so, by all means, stop one of us at the Annual Scientific Meeting, send emails, call, whatever you would like to do! Hope to see many of you in Seattle. Stop me and say hello!
Gailen D. Marshall Jr., MD, PhD, FACAAI