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Stakeholder Opinions Asthma Phenotypes A changing paradigm

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Stakeholder Opinions: Asthma Phenotypes A changing paradigm

Description:       Introduction


                   An estimated 34 million people are diagnosed with asthma in the major markets. The disease can be broken
                   down into various phenotypes, differentiated by severity, trigger, or predominant inflammatory type. These
                   phenotypes may have important consequences for future approaches to treat asthma in a more targeted
                   fashion, doing away with the one-size-fits-all approach.


                   Scope


                   Analysis of the main asthma phenotypes and their pathobiological characteristics Overview of the prevalence
                   of the main phenotypes in asthma Assessment of key unmet needs and the opportunities they offer for new
                   product development Analysis of the future role of phenotypes and their impact in drug development


                   Highlights


                   Refractory asthma seems to be resistant to corticosteroids, and some refractory patients also suffer from
                   chronic airflow obstruction. Resistant disease is thought to afflict about 10% of asthma patients, whose unmet
                   medical needs are for obvious reasons very high. On average, 60% of the adult asthmatic population suffer
                   from allergic asthma. These patients are often well controlled with an early onset of disease and less severe
                   symptoms compared to the non-allergic phenotype. Immunotherapy is suggested to be beneficial for some of
                   the more severe allergic asthmatics. Two inflammatory phenotypes dominate in asthma: eosinophilic and
                   neutrophilic. These types of inflammation can be seen across a variety of phenotypes, although it is thought
                   that eosinophilic inflammation is mostly associated with allergic asthma and neutrophilic inflammation is
                   associated with refractory asthma and chronic airflow obstruction.


                   Reasons to Purchase


                   Evaluate different asthma phenotypes and their prevalence in the seven major markets Explore differential
                   treatment and the unmet needs of the most important asthma phenotypes Appreciate the impact of various
                   phenotypes on the future of drug development for asthma

Table Of           ABOUT DATAMONITOR HEALTHCARE 2
Contents:



PDF Brochure, Page 1
                 About the Infectious Diseases and Respiratory (ID&R) analysis team 2
                 CHAPTER 1 EXECUTIVE SUMMARY 3
                 Scope of the report 3
                 Contributing experts 3
                 Datamonitor insight into asthma phenotypes 4
                 CHAPTER 2 ASTHMA BACKGROUND AND EPIDEMIOLOGY 11
                 Disease definition 11
                 Causes of asthma: environment and genes 11
                 Etiology 14
                 Disease classification and phenotypes 16
                 Phenotypes 18
                 Prevalence 21
                 CHAPTER 3 ASTHMA DIAGNOSIS AND TREATMENT OPTIONS 24
                 Presentation and diagnosis 24
                 Treatment options and guidelines 25
                 Bronchodilators 26
                 Beta2-agonists 27
                 Anticholinergics 28
                 Combination beta2-agonist/anticholinergic 28
                 Anti-inflammatories 29
                 Inhaled corticosteroids 29
                 Systemic corticosteroids 30
                 Non-steroidal anti-inflammatory drugs (NSAIDs) 30
                 ICS/LABA combinations 32
                 Biologicals 33
                 Future trends in asthma treatment 33
                 Asthma biomarkers 34
                 CHAPTER 4 CLINICAL OR PHYSIOLOGICAL PHENOTYPES 38
                 Severity-defined asthma 38
                 Prevalence 40
                 Refractory asthma 42
                 Pathobiology 44
                 The refractory asthma patient 46
                 Prevalence 47
                 Treatment 48
                 The exacerbation-prone subtype of refractory asthma 50
                 Chronic airflow obstruction in asthma 51
                 Pathobiology 51




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                 The asthma patient with chronic airflow obstruction 54
                 Prevalence 56
                 Treatment 59
                 Asthma defined by age of onset 60
                 The early- versus late-onset patient 60
                 Treatment 62
                 Nocturnal asthma 63
                 Pathobiology 64
                 Prevalence 65
                 Treatment 66
                 Viral infections during childhood 66
                 Asthma and obesity 68
                 CHAPTER 5 PHENOTYPES RELATED TO CERTAIN TRIGGERS 72
                 Environmental allergens 72
                 Pathobiology 73
                 The allergic march 75
                 The allergic versus non-allergic asthma patient 77
                 Prevalence 79
                 Treatment 82
                 Immunotherapy 82
                 Aspirin- and NSAID-sensitive asthma 85
                 The aspirin-sensitive asthma patient 85
                 Prevalence 86
                 Treatment 88
                 Occupational allergens or irritants 89
                 Prevalence 92
                 Treatment 93
                 Menses-related asthma 94
                 Exercise-induced asthma 95
                 Treatment 96
                 CHAPTER 6 INFLAMMATORY PHENOTYPES 98
                 Eosinophilic inflammatory asthma 99
                 Prevalence 100
                 Neutrophilic inflammatory asthma 103
                 The neutrophilic asthma phenotype 105
                 Prevalence 106
                 Pauci-granulocytic inflammatory asthma 108
                 Prevalence 108




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                 CHAPTER 7 ASTHMA PHENOTYPES IN THE FUTURE 111
                 Why and how could we use phenotypes? 112
                 Phenotypes and endpoints 113
                 New endpoints 114
                 The battle over asthma control 116
                 Phenotypes and biomarkers 117
                 How can we progress the identification of phenotypes? 118
                 Which phenotype should we target first? 120
                 Case study 1: Xolair (omalizumab) in severe allergic asthma 125
                 Case study 2: Immunotherapy in severe allergic asthma 127
                 Case study 3: an anti-inflammatory drug in neutrophilic asthma 129
                 REFERENCES 132
                 Disclaimer 178
                 List of Tables
                 Table 1: Asthma prevalence and diagnosed population by country and age, 2007 23
                 Table 2: Diagnosed asthma by country and severity for children and adults/elderly, 2007 41
                 Table 3: Prevalence of severe/refractory asthma by country, 2007 47
                 Table 4: Prevalence of exacerbation-prone severe/refractory asthma by country, 2007 51
                 Table 5: Prevalence of chronic airflow obstruction in diagnosed adult/elderly and pediatric asthma population
                 by country (000s), 2007 58
                 Table 6: Prevalence of diagnosed asthma patients with nocturnal symptoms in the seven major markets
                 (million), 2007 65
                 Table 7: The prevalence of allergic and non-allergic asthma in the seven major markets, 2007 ('000) 80
                 Table 8: Prevalence of allergic asthma according to severity in the seven major markets, 2007 ('000) 81
                 Table 9: Range of prevalence of diagnosed asthma patients with aspirin/NSAID sensitive asthma, 2007 88
                 Table 10: Prevalence of occupational asthma in the diagnosed adult asthma population, 2007 93
                 Table 11: Prevalence of diagnosed asthma patients with predominantly eosinophilic inflammation, 2007 ('000)
                 102
                 Table 12: Prevalence of diagnosed asthma patients with predominantly neutrophilic inflammation, 2007 107
                 Table 13: Prevalence of different inflammatory phenotypes in diagnosed asthmatic children, adults and
                 elderly, 2007 ('000) 110
                 Table 14: Marketed and pipeline therapies in eosinophilic and neutrophilic inflammation 125
                 List of Figures
                 Figure 1: Basic etiology of asthma 16
                 Figure 2: Levels of asthma control according to the GINA guidelines 18
                 Figure 3: Early/childhood onset phenotypes 20
                 Figure 4: Late/adult onset phenotypes 20
                 Figure 5: Percentage of asthma patients who experience daily or weekly symptoms by age, 2004 24




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                 Figure 6: Management approach based on asthma control 26
                 Figure 7: Novel asthma therapies are moving towards targeted therapy 34
                 Figure 8: The role of biomarkers related to asthma therapy 36
                 Figure 9: Overview of clinical or physiological phenotypes 38
                 Figure 10: Classification of asthma by clinical, pretreatment features 39
                 Figure 11: ATS workshop consensus for definition of refractory asthma 43
                 Figure 12: A normal airway compared to the process in airway remodeling 53
                 Figure 13: Early-onset versus late-onset asthma 61
                 Figure 14: Circadian alterations in lung function in healthy subjects and patients with nocturnal asthma 63
                 Figure 15: Viral infections have been implicated in at least three ways with asthma pathogenesis 67
                 Figure 16: Overview of phenotypes related to certain triggers 72
                 Figure 17: The early and late allergic response 73
                 Figure 18: Proposed systemic inflammatory mechanisms linking the upper and lower airways 75
                 Figure 19: The allergic march 77
                 Figure 20: Prevalence of aspirin-sensitive asthma according to studies versus key opinion leaders (KOLs) 87
                 Figure 21: Categories and subcategories of occupational asthma 90
                 Figure 22: Overview of inflammatory phenotypes 98
                 Figure 23: Characteristics of eosinophil-positive (+) and eosinophil-negative (-) severe asthma 104
                 Figure 24: The complex relation between various triggers of airway inflammation and the diseases associated
                 with them 111
                 Figure 25: Exacerbations in patients following guideline-therapy and sputum-identification therapy 113
                 Figure 26: How can we progress the identification of asthma phenotypes? 119
                 Figure 27: The reaction of neutrophils to CXC chemokines in the early phase of inflammation 123
                 Figure 28: The difference between potential US peak sales and actual US sales of Xolair in allergic asthma
                 127
                 Figure 29: Possible US peak sales of Grazax in allergic asthma 129
                 Figure 30: Possible US peak sales of a novel anti-inflammatory in neutrophilic asthma 131




PDF Brochure, Page 5

								
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