Andrew Gillman

•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)