Post on 06-Dec-2015
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•National Asthma Guidelines – www.nationalasthma.org.au Updated 20014
•Worldwide Asthma Guidelines - GINA (Global INitiative for Asthma) www.ginasthma.com – Updated 20014
•GINA - “The goal of asthma care is to “maintain control” and prevent “future risk””
•Eric Bateman (GOAL 2004) – “Asthmatic but without Asthma”
“Total Control” -
Daytime Symptoms/Reliever <2x week
No nocturnal symptoms
No limitation of activities
Normal Lung Function – Spirometry/PEFR
“Future Risk” – of
exacerbations
decline in lung function and
medication side effects
Validated measures for assessing Asthma Control
Asthma Control Questionnaire (ACQ) – The ACQ asks 6
questions related to asthma control over 1 week and also spirometry. The full ACQ score is the mean of the 7 items (<0.75, well controlled; 0.75–1.5, not well controlled; >1.5, uncontrolled)
Asthma Control Test (ACT) The ACT asks 5 questions
related to a patient's asthma control over the previous 4 weeks. Scores range from 5 to 25 and higher scores indicate better control. If a patient scores 19 or less, the asthma is considered not well
controlled
Phenotypes
1. Allergic vs Non Allergic
IgE – Omalizumab
IgE > 70 ?
Sensitisation to a perennial allergen
2.Eosinophilic vs Non Eosinophilic
IL5 – Mepolizumab - EMA approved 2015
Benralizumab
Reslizumab
IL-13 and IL4 – Dupilumab (Eczema / Polyps)
Sputum Eosinophils > 3%
Serum Eosinphils >0.3
FENO > 50 PPB
3. Th2 high vs Th2 Low = Periostin High
IL-13 is a Th2 Cytokine
IL-13 triggers bronchial epithelial cells to produce PERIOSTIN, an extracellular matrix protein
Autocrine Action – Airway lining
Paracrine Action – Fibroblasts
= Airway inflammation and remodelling
Periostin surrogate for IL-13
TH2 HIGH vs TH2 LOW
TH2 High = Elevated IgE (>100) and Eosinophil count (>0.14)