Current opinion in pulmonary medicine
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Despite advances in our understanding of the obese asthma phenotype, heterogeneity and large gaps in knowledge have hindered significant advances in directed interventions. ⋯ Obesity confounds traditional asthma biomarkers and lung function measurements, thus defining obese asthma endotypes remains challenging. Novel pathways are being identified and hold promise for future targeted therapies. However, we are in dire need of updated guidelines regarding asthma diagnosis in obese patients and the development of biomarkers that more accurately identify specific endotypes.
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To discuss the current use of oral corticosteroids (OCS) as a chronic treatment in patients with severe asthma and as a rescue treatment for patients presenting with acute exacerbations. ⋯ Longer term, there are real prospects that chronic and acute OCS use in asthma will be replaced by biological agents targeting eosinophilic airway inflammation more specifically and safely.
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The long-term management goals of the inflammatory airway diseases asthma and chronic obstructive pulmonary disease (COPD) are similar and focus on symptom control and reduction of exacerbation frequency and severity. Treatable traits have recently been postulated as a management concept which complements the traditional diagnostic labels 'asthma' and 'COPD', thereby focusing on therapy targeted to a patients' individual disease-associated characteristics. Exhaled volatile organic compounds (VOCs) may be utilized as noninvasive biomarker for disease activity or manifestation in asthma and COPD. In this review, we provide an overview of the current achievements concerning exhaled breath analysis in the field of uncontrolled chronic airways diseases. ⋯ Exhaled VOC analysis and the management of asthma and COPD through the concept of pulmonary treatable traits are an interesting match. To develop exhaled breath analysis into an added value for pulmonary treatable traits, multicentre studies are required following international standards for study populations, sampling methods and analytical strategies enabling external validation.