Stakeholder Opinions: Asthma Phenotypes – A changing paradigm
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the Infectious Diseases and Respiratory (ID&R) analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the report - page 3
- Contributing experts - page 3
- Datamonitor insight into asthma phenotypes - page 4
- CHAPTER 2 ASTHMA BACKGROUND AND EPIDEMIOLOGY - page 11
- Disease definition - page 11
- Causes of asthma: environment and genes - page 11
- Etiology - page 14
- Disease classification and phenotypes - page 16
- Phenotypes - page 18
- Prevalence - page 21
- CHAPTER 3 ASTHMA DIAGNOSIS AND TREATMENT OPTIONS - page 24
- Presentation and diagnosis - page 24
- Treatment options and guidelines - page 25
- Bronchodilators - page 26
- Beta2-agonists - page 27
- Anticholinergics - page 28
- Combination beta2-agonist/anticholinergic - page 28
- Anti-inflammatories - page 29
- Inhaled corticosteroids - page 29
- Systemic corticosteroids - page 30
- Non-steroidal anti-inflammatory drugs (NSAIDs) - page 30
- ICS/LABA combinations - page 32
- Biologicals - page 33
- Future trends in asthma treatment - page 33
- Bronchodilators - page 26
- Asthma biomarkers - page 34
- CHAPTER 4 CLINICAL OR PHYSIOLOGICAL PHENOTYPES - page 38
- Severity-defined asthma - page 38
- Prevalence - page 40
- Refractory asthma - page 42
- Pathobiology - page 44
- The refractory asthma patient - page 46
- Prevalence - page 47
- Treatment - page 48
- The exacerbation-prone subtype of refractory asthma - page 50
- Chronic airflow obstruction in asthma - page 51
- Pathobiology - page 51
- The asthma patient with chronic airflow obstruction - page 54
- Prevalence - page 56
- Treatment - page 59
- Asthma defined by age of onset - page 60
- The early- versus late-onset patient - page 60
- Treatment - page 62
- Nocturnal asthma - page 63
- Pathobiology - page 64
- Prevalence - page 65
- Treatment - page 66
- Viral infections during childhood - page 66
- Asthma and obesity - page 68
- Severity-defined asthma - page 38
- CHAPTER 5 PHENOTYPES RELATED TO CERTAIN TRIGGERS - page 72
- Environmental allergens - page 72
- Pathobiology - page 73
- The allergic march - page 75
- The allergic versus non-allergic asthma patient - page 77
- Prevalence - page 79
- Treatment - page 82
- Immunotherapy - page 82
- Aspirin- and NSAID-sensitive asthma - page 85
- The aspirin-sensitive asthma patient - page 85
- Prevalence - page 86
- Treatment - page 88
- Occupational allergens or irritants - page 89
- Prevalence - page 92
- Treatment - page 93
- Menses-related asthma - page 94
- Exercise-induced asthma - page 95
- Treatment - page 96
- Environmental allergens - page 72
- CHAPTER 6 INFLAMMATORY PHENOTYPES - page 98
- Eosinophilic inflammatory asthma - page 99
- Prevalence - page 100
- Neutrophilic inflammatory asthma - page 103
- The neutrophilic asthma phenotype - page 105
- Prevalence - page 106
- Pauci-granulocytic inflammatory asthma - page 108
- Prevalence - page 108
- Eosinophilic inflammatory asthma - page 99
- CHAPTER 7 ASTHMA PHENOTYPES IN THE FUTURE - page 111
- Why and how could we use phenotypes? - page 112
- Phenotypes and endpoints - page 113
- New endpoints - page 114
- The battle over asthma control - page 116
- Phenotypes and biomarkers - page 117
- How can we progress the identification of phenotypes? - page 118
- Phenotypes and endpoints - page 113
- Which phenotype should we target first? - page 120
- Case study 1: Xolair (omalizumab) in severe allergic asthma - page 125
- Case study 2: Immunotherapy in severe allergic asthma - page 127
- Case study 3: an anti-inflammatory drug in neutrophilic asthma - page 129
- Why and how could we use phenotypes? - page 112
- REFERENCES - page 132
- Disclaimer - page 178
- List of Tables
- Table 1: Asthma prevalence and diagnosed population by country and age, 2007 - page 23
- Table 2: Diagnosed asthma by country and severity for children and adults/elderly, 2007 - page 41
- Table 3: Prevalence of severe/refractory asthma by country, 2007 - page 47
- Table 4: Prevalence of exacerbation-prone severe/refractory asthma by country, 2007 - page 51
- Table 5: Prevalence of chronic airflow obstruction in diagnosed adult/elderly and pediatric asthma population by country (000s), 2007 - page 58
- Table 6: Prevalence of diagnosed asthma patients with nocturnal symptoms in the seven major markets (million), 2007 - page 65
- Table 7: The prevalence of allergic and non-allergic asthma in the seven major markets, 2007 ('000) - page 80
- Table 8: Prevalence of allergic asthma according to severity in the seven major markets, 2007 ('000) - page 81
- Table 9: Range of prevalence of diagnosed asthma patients with aspirin/NSAID sensitive asthma, 2007 - page 88
- Table 10: Prevalence of occupational asthma in the diagnosed adult asthma population, 2007 - page 93
- Table 11: Prevalence of diagnosed asthma patients with predominantly eosinophilic inflammation, 2007 ('000) - page 102
- Table 12: Prevalence of diagnosed asthma patients with predominantly neutrophilic inflammation, 2007 - page 107
- Table 13: Prevalence of different inflammatory phenotypes in diagnosed asthmatic children, adults and elderly, 2007 ('000) - page 110
- Table 14: Marketed and pipeline therapies in eosinophilic and neutrophilic inflammation - page 125
- List of Figures
- Figure 1: Basic etiology of asthma - page 16
- Figure 2: Levels of asthma control according to the GINA guidelines - page 18
- Figure 3: Early/childhood onset phenotypes - page 20
- Figure 4: Late/adult onset phenotypes - page 20
- Figure 5: Percentage of asthma patients who experience daily or weekly symptoms by age, 2004 - page 24
- Figure 6: Management approach based on asthma control - page 26
- Figure 7: Novel asthma therapies are moving towards targeted therapy - page 34
- Figure 8: The role of biomarkers related to asthma therapy - page 36
- Figure 9: Overview of clinical or physiological phenotypes - page 38
- Figure 10: Classification of asthma by clinical, pretreatment features - page 39
- Figure 11: ATS workshop consensus for definition of refractory asthma - page 43
- Figure 12: A normal airway compared to the process in airway remodeling - page 53
- Figure 13: Early-onset versus late-onset asthma - page 61
- Figure 14: Circadian alterations in lung function in healthy subjects and patients with nocturnal asthma - page 63
- Figure 15: Viral infections have been implicated in at least three ways with asthma pathogenesis - page 67
- Figure 16: Overview of phenotypes related to certain triggers - page 72
- Figure 17: The early and late allergic response - page 73
- Figure 18: Proposed systemic inflammatory mechanisms linking the upper and lower airways - page 75
- Figure 19: The allergic march - page 77
- Figure 20: Prevalence of aspirin-sensitive asthma according to studies versus key opinion leaders (KOLs) - page 87
- Figure 21: Categories and subcategories of occupational asthma - page 90
- Figure 22: Overview of inflammatory phenotypes - page 98
- Figure 23: Characteristics of eosinophil-positive (+) and eosinophil-negative (-) severe asthma - page 104
- Figure 24: The complex relation between various triggers of airway inflammation and the diseases associated with them - page 111
- Figure 25: Exacerbations in patients following guideline-therapy and sputum-identification therapy - page 113
- Figure 26: How can we progress the identification of asthma phenotypes? - page 119
- Figure 27: The reaction of neutrophils to CXC chemokines in the early phase of inflammation - page 123
- Figure 28: The difference between potential US peak sales and actual US sales of Xolair in allergic asthma - page 127
- Figure 29: Possible US peak sales of Grazax in allergic asthma - page 129
- Figure 30: Possible US peak sales of a novel anti-inflammatory in neutrophilic asthma - page 131
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