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Small airways summit2018

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WG REG Summit 2018

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Small airways summit2018

  1. 1. REG Summit Amsterdam, 22nd March 2018 Small Airways Working Group Meeting
  2. 2. Agenda • Working group progress update o Published studies o Active studies • Proposed projects o The effects of obesity, weight loss and weight loss surgery on asthma o Making sense of dose • Areas of future research • Additional items
  3. 3. Attendees • O Usmani (chair)
  4. 4. Progress update • Recently published studies o Risk of pneumonia in obstructive lung disease: A real-life study comparing extra-fine and fine-particle inhaled corticosteroids (PLOS One, Jun 17) o Extrafine versus fine inhaled corticosteroids in relation to asthma control: A systematic review and meta-analysis of observational real-life studies, (JACI, Sep 17) o Harmonizing the nomenclature for therapeutic aerosol particle size: A proposal (Journal of Aerosol Medicine and Pulmonary Drug Delivery, Nov 17)
  5. 5. Active studies: Preschool wheeze • Comparative effectiveness of guideline recommended treatment options for patients with pre-school asthma / wheeze • Historical matched cohort analysis showed no significant differences in wheezing/asthma attack rates during the outcome year in any of the four treatment comparisons. • The findings suggest that watchful waiting, in conjunction with as- needed symptom management, may be the best approach for many children with preschool wheeze. o Presented as a poster at ERS Manuscript under revision
  6. 6. Active studies: Asthma State of the Union • Characterisation of current asthma management practice and asthma-related morbidity (State of the Union) • Manuscript was under development when the following was published: “We have undertaken the first descriptive study of the UK’s general asthma population.”
  7. 7. Asthma State of the Union • Rethink the Asthma State of the Union o Trends in exacerbations, medication use and adherence over time o Keeping it as simple as possible • Descriptive ecological study o Population: – Asthma patients with at least on prescription for asthma therapy in the year of study o Sampled each year for 20 years o Prevalent and incident asthma per year; proportion experiencing asthma exacerbations each year o Split by key demographic factors and proportion at each GINA step
  8. 8. Asthma State of the Union • Key methodological questions o Discussion of study design – is a descriptive study enough? o Do we need to include a measure of control?
  9. 9. Proposed projects: Obesity, weight loss and asthma • Objective: o Quantify the effect of BMI, weight loss, and type of weight loss on asthma symptoms and control and the relationship with GERD • Rationale: o Obesity and asthma frequently occur together but the exact relationship and mechanisms are unclear o Weight loss improves asthma symptoms, but the amount of weight loss required is unclear o GERD is associated with both asthma and obesity, making it a key confounding factor o Existing studies on the effects of bariatric surgery in asthma patients have been small
  10. 10. Proposed projects: Obesity, weight loss and asthma • Methods: o Two retrospective cohort analyses of the OPCRD – Analysis 1: Quantifying the effects of BMI on asthma symptoms and control  Inclusion: ≥18 yrs of age, asthma diagnosis, BMI in baseline and outcome  Exclusion: COPD or cancer diagnosis; or ≥65 yrs of age Baseline year: Clinical and demographic characterisation Obese patients Non-obese patients Primary 2-year outcome period Exploratory 5-year outcome period Asthma diagnosis
  11. 11. Analysis 1: Quantifying the effects of BMI on asthma symptoms and control • Primary outcomes o Asthma exacerbations, asthma quality of life, asthma medication • Exploratory outcomes o Small airways function, dose response between BMI and asthma symptoms, GERD status, weight loss/gain, serum C reactive protein • Sub-group analyses o Severe asthma, gender, obesity class, asthma phenotype
  12. 12. Proposed projects: Obesity, weight loss and asthma • Methods: – Analysis 2: Quantifying the effects of weight loss on asthma symptoms and control in obese patients  Inclusion: ≥18 yrs of age, asthma diagnosis, BMI >30 in baseline, weight recorded at least once in outcome  Exclusion: COPD or cancer diagnosis; or ≥65 yrs of age Baseline year: Clinical and demographic characterisation Obese + weight loss 5-year outcome period Date at which maximum weight loss occurred (a minimum will be set in analysis 1) Obese - weight loss Obese + surgery weight loss Obese + non-surgery weight loss
  13. 13. Analysis 2: Quantifying the effects of weight loss on asthma symptoms and control in obese patients • Primary outcomes o Asthma exacerbations, asthma quality of life, asthma medication • Exploratory outcomes o Small airways function, dose response between weight loss and asthma symptoms, GERD status • Sub-group analyses o Severe asthma, gender, asthma phenotype, weight regain
  14. 14. Next steps • Sample dataset from OPCRD to test feasibility and sample size • Determine PI and steering committee • Protocol development • Future analyses: o The comparative effectiveness of extra-fine and fine inhaled corticosteroids in asthma patients with and without obesity o Effect of GERD surgery on asthma o Effect of obesity and weight loss on asthma in children
  15. 15. Proposed projects: Making sense of dose • Objective: o An editorial on what is meant by “lung dose” • Rationale: o Following reviewer comments in response to a manuscript on extra fine versus fine ICS, it is clear that there are multiple definitions of “equivalent dose” • Methods: o Ask a range of professions what “dose” means to them: – Physicist – Pharmacologist – Primary care practitioner – Paediatrician – Physician (secondary care) – Pharmaceutical regulator – Professor of receptor or molecular science – Physiologist
  16. 16. Future interests • What are the priorities for the working group? • Do the current projects match with priorities? • Are there other projects we should be exploring?
  17. 17. Any other business?

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