Asthma endotypes: A new approach to classification of disease entities within the asthma syndrome - 10/08/11
, Cezmi A. Akdis, MD b, Leonard B. Bacharier, MD c, Leif Bjermer, MD d, Thomas B. Casale, MD e, Adnan Custovic, MD f, Robert F. Lemanske, MD g, Andrew J. Wardlaw, MD h, Sally E. Wenzel, MD i, Paul A. Greenberger, MD j
Reprint requests: Jan Lötvall, MD, Krefting Research Centre, University of Gothenburg, PO Box 480, SE 405 30 Göteborg, Sweden.Abstract |
It is increasingly clear that asthma is a complex disease made up of number of disease variants with different underlying pathophysiologies. Limited knowledge of the mechanisms of these disease subgroups is possibly the greatest obstacle in understanding the causes of asthma and improving treatment and can explain the failure to identify consistent genetic and environmental correlations to asthma. Here we describe a hypothesis whereby the asthma syndrome is divided into distinct disease entities with specific mechanisms, which we have called “asthma endotypes.” An “endotype” is proposed to be a subtype of a condition defined by a distinct pathophysiological mechanism. Criteria for defining asthma endotypes on the basis of their phenotypes and putative pathophysiology are suggested. Using these criteria, we identify several proposed asthma endotypes and propose how these new definitions can be used in clinical study design and drug development to target existing and novel therapies to patients most likely to benefit.
This PRACTALL (PRACtical ALLergy) consensus report was produced by experts from the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology.
Le texte complet de cet article est disponible en PDF.Key words : Asthma, endotype, phenotype, cluster analysis, pathophysiology, epidemiology
Abbreviations used : ABPM, API, ASA, NSAID
Plan
| Disclosure of potential conflict of interest: J. Lötvall is a consultant for GlaxoSmith-Kline and Merck (MSD); receives speakers’ fees from GlaxoSmithKline, Astra-Zeneca, and Merck; receives research support from the Kreftin Foundation against asthma/allergy, the Swedish Medical Research Council, GlaxoSmithKline, AstraZeneca, and Novartis; and is president of the European Academy of Allergy and Clinical Immunology. C. A. Akdis receives research support from Novartis, Stallergenes, the Swiss National Science Foundation, the Global Allergy and Asthma European Network, and the Christine Kuhne Center for Allergy Research; has consultant arrangements with Actellion, Aventis, and Allergopharma; is a fellow and interest group member of the American Academy of Allergy, Asthma & Immunology; is vice-president of the European Academy of Allergy and Clinical Immunology; and is an ex–committee member WP leader for GA2LEN. L. B. Bacharier receives honoraria from AstraZeneca, Genentech, GlaxoSmithKline, Merck, Schering-Plough, and Aerocrine and is on advisory boards for Genentech, Glaxo-SmithKline, Merck, Schering-Plough, and Aerocrine. T. B. Casale is executive vice-president of the American Academy of Allergy, Asthma & Immunology. A. Custovic receives research support from the Medical Research Council and the Moulton Charitable Trust. R. F. Lemanske Jr is a speaker for Merck, AstraZeneca, Doembacher Children’s Hospital, Washington University, Medicus Group, Park Nicolet Institute, ACAAI, LA Allergy Society, Michigan Allergy/Asthma Society, Medical College of Wisconsin, Fund for Medical Research and Education (Detroit), Children’s Hospital of Minnesota, Toronto Allergy Society, American Academy of Allergy, Asthma & Immunology, Beaumont Hospital (Detroit), University of Illinois, Canadian Society of Allergy and Clinical Immunology, New York Presbyterian, Med Media Educational Group, Onpointe Medical Communication, Medical University of South Carolina, Health Matters Communication, Bishop McCann, Donohue, Purohit, Miller, Inc, Center for Health Care Education, University of California–San Francisco, American Thoracic Society, University of Iowa, Indiana University, American Lung Association of Upper Midwest, Vanderbilt University, and Rochester Children’s Hospital; has consultant arrangements with AstraZeneca, Map Pharmaceuticals, Gray Consulting, Smith Research, Inc, Merck Childhood Asthma Network, Novartis, Quintiles/Innovax, RC Horowitz and Co, Inc, International Meetings and Science, Scienomics, Scientific Therapeutics, and Cognimed, Inc; is an author for Up-to-Date; and is a textbook editor for Elsevier. A. J. Wardlaw is on the advisory boards for GlaxoSmithKline and Cephalon and receives research support from GlaxoSmithKline, Pfizer, and AstraZeneca. S. E. Wenzel is a consultant for GlaxoSmithKline, Merck, and Amira and receives research support from GlaxoSmithKline, MedImmune, and Amgen. P. A. Greenberger is on the advisory board for Mylan (Dey); has provided legal consultation or expert witness testimony in cases related to drug allergy, immunology of IBD, and asthma; and is a past president of the American Academy of Allergy, Asthma & Immunology. The other author has declared that he has no conflict of interest. |
Vol 127 - N° 2
P. 355-360 - février 2011 Retour au numéro
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