Clinical and biological markers of asthma control

Abstract

Asthma has substantial impact on the patient, their family and health systems, and its control has gained increasing attention. Perception of asthma control has varied widely among patients as well as healthcare providers. Several clinical markers have been developed to define and standardize the measurement of asthma control. They are based primarily on patients’ symptoms and have been popular in clinical practice and in clinical studies. With the advances in basic research on the pathology of asthma, several biological markers have evolved that have the advantages of being objective, quantitative and more reflective of the underlying pathology, which makes them a better guide for selecting optimal therapy. In addition to the cost and expertise required, biological makers are influenced by multiple factors that limit their application in clinical practice. Ongoing research is expected to define the role of individual biological markers, the optimal method of their application, and their appropriate interpretation.

Keywords::

• asthma control
• Asthma Control Questionnaire
• Asthma Control Test
• asthma evaluation
• asthma markers
• eosinophil cationic protein
• exhaled nitric oxide
• GINA
• JTFPP
• NAEPP
• serum periostin
• sputum eosinophils
• urinary leukotriene E4

Acknowledgement

The authors thank Caleb Sheaffer for assisting in grammatical review of this manuscript.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Information has been accumulating to emphasize that asthma is a heterogeneous disease, with multiple phenotypes.

• In any individual patient, asthma severity is a dynamic state.

• Several guidelines for asthma management have been developed, yet a substantial proportion of patients have uncontrolled asthma, even in developed countries.

• Emphasis in recent years has been on prescribing treatment of asthma proportionate to its severity as well as periodic monitoring of asthma control.

• Multiple clinical markers for asthma control assessment have been available and are easy to apply, yet their use in clinical practice remains suboptimal.

• Correlations among clinical markers are suboptimal; therefore, the same method should be used for comparisons.

• Biological markers for asthma have been evolving with the advantage of being more quantitative and more reflective of the type of airway inflammation, yet have multiple limitations that hinder their application in clinical practice.

• It seems that different biological markers reflect different aspects of the underlying pathology in the airways.

• Ongoing research is expected to lead to the development of markers that can be both reliable and applicable to routine management of asthma.

Notes

Reprinted from [34].

Reproduced with permission from © Elsevier.