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Type 2 biomarkers in predicting asthma control during step-down therapy

Published online: July 18, 2020

Type 2 biomarkers of inflammation are used to guide asthma management in uncontrolled disease. Elevated biomarkers such as fractional exhaled nitric oxide (FeNO), have been linked to increased asthma morbidity and have been proposed as a useful tool to guide therapeutic decisions. However, it is not known whether these biomarkers are predictive of loss of control among patients with well-controlled asthma undergoing step-down therapy.   

In a study recently published in The Journal of Allergy and Clinical Immunology: In Practice, Bose, et al performed a sub-analysis of a multicenter randomized, double-blind clinical trial (Long-Acting Beta-Agonist Step-Down Study, or LASST) that was designed to compare strategies for managing patients with well-controlled asthma. The purpose of this sub-study was to determine if biomarkers such as FeNO, serum aeroallergen multi-allergy screening tests (Phadiatop), and eosinophil peroxidase assays at baseline, or FeNO serially, could predict the loss of asthma control.

Results of the study demonstrated that baseline biomarkers, including FeNO, Phadiatop, and eosinophil peroxidase, did not clearly predict subsequent treatment failure among adults with well-controlled asthma enrolled in a trial of step-down therapy. There was no influence of treatment group on this lack of association. Furthermore, serial levels of FeNO at 6-week intervals demonstrated that intermediate and high levels were also not predictive of subsequent loss of asthma control. The results highlight that these biomarkers may not have utility for guiding asthma management in well-controlled patients.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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