Asthma guidelines and severe asthma - a Twitter summary from the 2012 WSAAI meeting

This summary was compiled from the tweets posted by @MatthewBowdish, an allergist/immunologist, who attended the 2012 Western Society of Allergy, Asthma and Immunology (WSAAI) meeting. The tweets were labeled #WSAAI. The text was edited and modified by me.

Asthma guidelines

Paul O'Byrne discussed asthma guidelines across borders:

Previous models on asthma guidelines were based on stepwise approach with regards to severity and treatment - but it was difficult to determine asthma severity based on steps. We were only able to determine severity based on initial treatment. Now, asthma control is the key. Everyone can define control: symptoms, limitation of activities, need for short-terms medications (SABA) and lung function.

Asthma guidelines are similar in major treatment recommendations across many countries.

There is clear evidence of ICS/LABA efficacy.

Using ICS/LABA as rescue (“SMART” approach) can be helpful (though not FDA-approved) by getting ICS into patient’s lungs at the beginning of the asthma exacerbation.

Severe Asthma - From Asthma Endotypes to Personalized Medicine

Dr. Paul O'Byrne presented "From Asthma Endotypes to Personalized Medicine”:

For most asthmatic patients, empiric treatment is quite effective for asthma therapy. Genotyping/phenotyping are really for severe, uncontrolled patients with asthma.

What is asthma endotype?

Definition of asthma endotype: distinct disease entities which may be present in cluster of phenotypes but each is defined by a specific biological mechanism.

Severe asthma (click to enlarge the image).

Bronchial thermoplasty

Bronchial thermoplasty (BT) uses radiofrequency energy that is converted to heat in the airway way. Thus, bronchial thermoplasty ablates the increased volume of smooth muscle of the treated airway.

BT leads to decreased severe exacerbations, decreased rescue medication use, increased FEV1 (15% pre-bronchodilator), and increased AQL score.

BT is not free of adverse effects. Bronchial thermoplasty has caused hospitalizations but no deaths.

RCTs of Bronchial Thermoplasty for Severe Asthma haven't shown reduction in airway hyperresponsiveness or FEV1 change, Am. J. Respir. Crit. Care Med. April 1, 2012 vol. 185 no. 7 709-714.

Anti-IL5 treatment (mepolizumab)

Anti-IL5 reduces esosinophilic asthma exacerbations but has not been shown to reduce allergen-induced airway responses. With anti-IL5, FEV1 increased and the need for oral prednisone decreased in a subpopulation of patients with eosinophilic asthma.


Two anti-IL13 drugs are being evaluated. Lebrikuzumab improves FEV1 in asthmatics with higher blood periostin levels.

This summary was compiled from some of the tweets posted by @MatthewBowdish . The tweets were labeled #WSAAI and they reached more than 3,000 people. I would strongly encourage you to post updates on Twitter from the CME conferences that you are planning to attend in the future. Here is how to do it: Twitter for Physicians: How to use Twitter to keep track of the latest news and scientific meetings, and share information with colleagues and patients.

Disclaimer: The text was edited, modified, and added to by me.


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