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  1. Article ; Online: Mild asthma: Lessons learned and remaining questions.

    Mohan, Arjun / Lugogo, Njira L

    Respiratory medicine

    2023  Volume 216, Page(s) 107326

    Abstract: Patients living with mild disease represent the largest proportion of asthma patients. There are significant challenges in proposing a definition that would best describe these patients, while also accurately identifying at-risk individuals. Current ... ...

    Abstract Patients living with mild disease represent the largest proportion of asthma patients. There are significant challenges in proposing a definition that would best describe these patients, while also accurately identifying at-risk individuals. Current literature suggests considerable inflammatory and clinical heterogeneity within this group. Research has shown that these patients are at risk of poor control, exacerbations, lung function decline, and death. Despite conflicting data on its prevalence, eosinophilic inflammation appears to be a predictor of poorer outcomes in mild asthma. There is an immediate need to better understand phenotypic clusters in mild asthma. It is also important to understand factors that influence disease progression and remission, as it is evident that both vary in mild asthma. Guided by robust literature that supports inhaled corticosteroid-based strategies over short-acting beta-agonist (SABA) reliant regimens, the management of these patients has evolved considerably. Unfortunately, SABA use remains high in clinical practice despite strong advocacy from the Global Initiative for Asthma. Future mild asthma research should explore the role of biomarkers, develop prediction tools based on composite risk scores, and explore targeted therapies at least for at-risk individuals.
    MeSH term(s) Humans ; Administration, Inhalation ; Asthma/diagnosis ; Asthma/drug therapy ; Asthma/epidemiology ; Disease Progression ; Adrenal Cortex Hormones/therapeutic use ; Biomarkers ; Anti-Asthmatic Agents/therapeutic use
    Chemical Substances Adrenal Cortex Hormones ; Biomarkers ; Anti-Asthmatic Agents
    Language English
    Publishing date 2023-06-15
    Publishing country England
    Document type Journal Article
    ZDB-ID 1003348-8
    ISSN 1532-3064 ; 0954-6111
    ISSN (online) 1532-3064
    ISSN 0954-6111
    DOI 10.1016/j.rmed.2023.107326
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  2. Article ; Online: Long-term safety, durability of response, cessation and switching of biologics.

    Mohan, Arjun / Qiu, Anna Y / Lugogo, Njira

    Current opinion in pulmonary medicine

    2024  Volume 30, Issue 3, Page(s) 303–312

    Abstract: Purpose of review: Severe asthma patients suffer from decreased quality of life, and increased asthma symptoms, exacerbations, hospitalizations, and risk of death. Biologics have revolutionized treatment for severe asthma. However, with multiple ... ...

    Abstract Purpose of review: Severe asthma patients suffer from decreased quality of life, and increased asthma symptoms, exacerbations, hospitalizations, and risk of death. Biologics have revolutionized treatment for severe asthma. However, with multiple biologic agents now available, clinicians must consider initial selection the long-term effectiveness of biologics. Additionally, patients have overlapping eligibilities and clinicians may consider switching between biologics for improved response. Finally, careful assessment of biologics cessation is needed for severe asthma patients who depend on these add-on therapies for asthma control.
    Recent findings: Evidence for long-term durability and safety varies by biologic agent. In general, initial benefits noted from these agents (ex. exacerbation reduction) is, at minimum, sustained with long term use. Rates of adverse events and serious adverse events, including those requiring cessation of a biologics are low with long term use. Further studies are needed to understand the development of antidrug antibodies but currently their prevalence rates are low. Adverse events and insufficient efficacy are common reasons for biologic cessation or switching. Discontinuation maybe associated with waning of benefits but can be considered in certain situations. Biologic switching can be associated with improved asthma control.
    Summary: Biologics are safe and effective long-term therapies for the management of asthma. Discontinuation must be carefully considered and if possible avoided. Reasons for insufficient efficacy must be evaluated and if needed, biologic switching should be considered.
    MeSH term(s) Humans ; Anti-Asthmatic Agents/adverse effects ; Anti-Asthmatic Agents/therapeutic use ; Asthma/drug therapy ; Biological Products/adverse effects ; Biological Products/therapeutic use ; Drug Therapy, Combination ; Quality of Life
    Chemical Substances Anti-Asthmatic Agents ; Biological Products
    Language English
    Publishing date 2024-03-01
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 1285505-4
    ISSN 1531-6971 ; 1070-5287 ; 1078-1641
    ISSN (online) 1531-6971
    ISSN 1070-5287 ; 1078-1641
    DOI 10.1097/MCP.0000000000001067
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  3. Article ; Online: Analyzing comorbidities and their influence on severe asthma: Another missing piece of the puzzle solved?

    Mohan, Arjun / Desai, Brinda / Lugogo, Njira

    Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology

    2024  Volume 132, Issue 3, Page(s) 259–260

    MeSH term(s) Humans ; Asthma/epidemiology ; Comorbidity
    Language English
    Publishing date 2024-01-01
    Publishing country United States
    Document type Editorial
    ZDB-ID 1228189-x
    ISSN 1534-4436 ; 0003-4738 ; 1081-1206
    ISSN (online) 1534-4436
    ISSN 0003-4738 ; 1081-1206
    DOI 10.1016/j.anai.2023.12.013
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  4. Article ; Online: Are We Poised to Change the Trajectory of Maintenance Oral Corticosteroid Use in Severe Asthma in the Age of Biologics?

    Lugogo, Njira / Mohan, Arjun

    Chest

    2022  Volume 162, Issue 1, Page(s) 4–5

    MeSH term(s) Administration, Oral ; Adrenal Cortex Hormones/therapeutic use ; Anti-Asthmatic Agents/therapeutic use ; Asthma/drug therapy ; Biological Products/therapeutic use ; Humans
    Chemical Substances Adrenal Cortex Hormones ; Anti-Asthmatic Agents ; Biological Products
    Language English
    Publishing date 2022-07-07
    Publishing country United States
    Document type Editorial ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1016/j.chest.2022.04.004
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  5. Article ; Online: Phenotyping, Precision Medicine, and Asthma.

    Mohan, Arjun / Lugogo, Njira L

    Seminars in respiratory and critical care medicine

    2022  Volume 43, Issue 5, Page(s) 739–751

    Abstract: The traditional one-size-fits all approach based on asthma severity is archaic. Asthma is a heterogenous syndrome rather than a single disease entity. Studies evaluating observable characteristics called phenotypes have elucidated this heterogeneity. ... ...

    Abstract The traditional one-size-fits all approach based on asthma severity is archaic. Asthma is a heterogenous syndrome rather than a single disease entity. Studies evaluating observable characteristics called phenotypes have elucidated this heterogeneity. Asthma clusters demonstrate overlapping features, are generally stable over time and are reproducible. What the identification of clusters may have failed to do, is move the needle of precision medicine meaningfully in asthma. This may be related to the lack of a straightforward and clinically meaningful way to apply what we have learned about asthma clusters. Clusters are based on both clinical factors and biomarkers. The use of biomarkers is slowly gaining popularity, but phenotyping based on biomarkers is generally greatly underutilized even in subspecialty care. Biomarkers are more often used to evaluate type 2 (T2) inflammatory signatures and eosinophils (sputum and blood), fractional exhaled nitric oxide (FeNO) and serum total and specific immunoglobulin (Ig) E reliably characterize the underlying inflammatory pathways. Biomarkers perform variably and clinicians must be familiar with their advantages and disadvantages to accurately apply them in clinical care. In addition, it is increasingly clear that clinical features are critical in understanding not only phenotypic characterization but in predicting response to therapy and future risk of poor outcomes. Strategies for asthma management will need to leverage our knowledge of biomarkers and clinical features to create composite scores and risk prediction tools that are clinically applicable. Despite significant progress, many questions remain, and more work is required to accurately identify non-T2 biomarkers. Adoption of phenotyping and more consistent use of biomarkers is needed, and we should continue to encourage this incorporation into practice.
    MeSH term(s) Asthma/drug therapy ; Asthma/therapy ; Biomarkers ; Eosinophils/metabolism ; Humans ; Immunoglobulin E ; Nitric Oxide/metabolism ; Nitric Oxide/therapeutic use ; Precision Medicine
    Chemical Substances Biomarkers ; Nitric Oxide (31C4KY9ESH) ; Immunoglobulin E (37341-29-0)
    Language English
    Publishing date 2022-10-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1183617-9
    ISSN 1098-9048 ; 1069-3424
    ISSN (online) 1098-9048
    ISSN 1069-3424
    DOI 10.1055/s-0042-1750130
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  6. Article: Tezepelumab for Severe Asthma: One Drug Targeting Multiple Disease Pathways and Patient Types.

    Panettieri, Reynold / Lugogo, Njira / Corren, Jonathan / Ambrose, Christopher S

    Journal of asthma and allergy

    2024  Volume 17, Page(s) 219–236

    Abstract: Asthma is a heterogeneous inflammatory disease of the airways, affecting many children, adolescents, and adults worldwide. Up to 10% of people with asthma have severe disease, associated with a higher risk of hospitalizations, greater healthcare costs, ... ...

    Abstract Asthma is a heterogeneous inflammatory disease of the airways, affecting many children, adolescents, and adults worldwide. Up to 10% of people with asthma have severe disease, associated with a higher risk of hospitalizations, greater healthcare costs, and poorer outcomes. Patients with severe asthma generally require high-dose inhaled corticosteroids and additional controller medications to achieve disease control; however, many patients remain uncontrolled despite this intensive treatment. The treatment of severe uncontrolled asthma has improved with greater understanding of asthma pathways and phenotypes as well as the advent of targeted biologic therapies. Tezepelumab, a monoclonal antibody, blocks thymic stromal lymphopoietin, an epithelial cytokine that has multifaceted effects on the initiation and persistence of asthma inflammation and pathophysiology. Unlike other biologic treatments, tezepelumab has demonstrated efficacy across severe asthma phenotypes, with the magnitude of effects varying by phenotype. Here we describe the anti-inflammatory effects and efficacy of tezepelumab across the most relevant phenotypes of severe asthma. Across clinical studies, tezepelumab reduced annualized asthma exacerbation rates versus placebo by 63-71% in eosinophilic severe asthma, by 58-68% in allergic severe asthma, by 67-71% in allergic and eosinophilic severe asthma, by 34-49% in type 2-low asthma, and by 31-41% in oral corticosteroid-dependent asthma. Furthermore, in all these asthma phenotypes, tezepelumab demonstrated higher efficacy in reducing exacerbations requiring hospitalizations or emergency department visits versus placebo. In patients with severe uncontrolled asthma, who commonly have multiple drivers of inflammation and disease, tezepelumab may modulate airway inflammation more extensively, as other available biologics block only specific downstream components of the inflammatory cascade.
    Language English
    Publishing date 2024-03-19
    Publishing country New Zealand
    Document type Journal Article ; Review
    ZDB-ID 2494877-9
    ISSN 1178-6965
    ISSN 1178-6965
    DOI 10.2147/JAA.S342391
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  7. Article ; Online: Use of ICS and Fast-Acting Bronchodilators in Asthma: Past, Present, and Future.

    Skolnik, Neil / Norden, Marissa / Lugogo, Njira / Wright, Wendy

    The Journal of family practice

    2023  Volume 72, Issue 6 Suppl, Page(s) S61–S70

    Abstract: Key takeaways: Primary care practitioners (PCPs) play a key role in asthma management since most patients with asthma are treated in primary care settings. Despite continual advances in asthma care, important practice gaps remain, and the high burden of ...

    Abstract Key takeaways: Primary care practitioners (PCPs) play a key role in asthma management since most patients with asthma are treated in primary care settings. Despite continual advances in asthma care, important practice gaps remain, and the high burden of asthma exacerbations persists, with 43% of children with asthma and 41% of adults with asthma in the United States experiencing an asthma exacerbation in 2020. Uncontrolled asthma, incomplete assessment of exacerbation and asthma control history, reliance on systemic corticosteroids (SCS) or short-acting beta2-agonist (SABA)-only therapy, and lack of patient adherence to anti-inflammatory maintenance therapies are challenges clinicians face today with asthma care. Inhaled corticosteroids (ICS) have been thought to have slow onset of action; however, recent data indicate that ICS onset of action on bronchial tissue is seconds to minutes through nongenomic effects. A large body of evidence supports the use of ICS + fast-acting bronchodilator treatments when used as needed in response to symptoms to improve asthma control and reduce rates of exacerbations. The symptoms that occur leading up to an asthma exacerbation provide a window of opportunity to intervene with ICS + fast-acting bronchodilators, potentially preventing the exacerbation and reducing the need for SCS. Incorporating patient perspectives and preferences when designing asthma regimens will help patients be more engaged in their therapy and may contribute to improved outcomes. In January 2023, a SABA-ICS combination rescue inhaler was approved by the US Food and Drug Administration (FDA) as the first asthma rescue inhaler for as-needed use to reduce the risk of exacerbations.
    MeSH term(s) Adult ; Child ; Humans ; Bronchodilator Agents/therapeutic use ; Anti-Asthmatic Agents/therapeutic use ; Drug Therapy, Combination ; Asthma/drug therapy ; Adrenal Cortex Hormones/therapeutic use ; Administration, Inhalation
    Chemical Substances Bronchodilator Agents ; Anti-Asthmatic Agents ; Adrenal Cortex Hormones
    Language English
    Publishing date 2023-08-03
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 197883-4
    ISSN 1533-7294 ; 0094-3509
    ISSN (online) 1533-7294
    ISSN 0094-3509
    DOI 10.12788/jfp.0625
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  8. Article ; Online: Utilizing Culturally Tailored Approaches and Participant Feedback to Successfully Implement an Exercise Intervention in Black Women with Asthma: Are There Lessons That Can Be Applied to Address Disparities in Asthma Outcomes?

    Press, Valerie G / Lugogo, Njira

    The journal of allergy and clinical immunology. In practice

    2021  Volume 9, Issue 12, Page(s) 4322–4323

    MeSH term(s) Asthma/epidemiology ; Asthma/therapy ; Blacks ; Exercise Therapy ; Feedback ; Female ; Hispanic or Latino ; Humans
    Language English
    Publishing date 2021-12-10
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 2843237-X
    ISSN 2213-2201 ; 2213-2198
    ISSN (online) 2213-2201
    ISSN 2213-2198
    DOI 10.1016/j.jaip.2021.09.015
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  9. Article ; Online: Type 2 Biomarkers in Asthma: Yet Another Reflection of Heterogeneity.

    Lugogo, Njira L / Akuthota, Praveen

    The journal of allergy and clinical immunology. In practice

    2021  Volume 9, Issue 3, Page(s) 1276–1277

    MeSH term(s) Asthma/diagnosis ; Biomarkers/metabolism ; Humans ; Inflammation ; Prevalence
    Chemical Substances Biomarkers
    Language English
    Publishing date 2021-03-08
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 2843237-X
    ISSN 2213-2201 ; 2213-2198
    ISSN (online) 2213-2201
    ISSN 2213-2198
    DOI 10.1016/j.jaip.2020.12.032
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  10. Article ; Online: The Use of Albuterol/Budesonide as Reliever Therapy to Reduce Asthma Exacerbations.

    Panettieri, Reynold A / Chipps, Bradley E / Skolnik, Neil / George, Maureen / Murphy, Kevin / Lugogo, Njira

    The journal of allergy and clinical immunology. In practice

    2024  Volume 12, Issue 4, Page(s) 882–888

    Abstract: Prevention of asthma exacerbations and reduction of systemic corticosteroid burden remain unmet needs in asthma. US asthma guidelines recommend concomitant short-acting ... ...

    Abstract Prevention of asthma exacerbations and reduction of systemic corticosteroid burden remain unmet needs in asthma. US asthma guidelines recommend concomitant short-acting β
    MeSH term(s) Humans ; Adolescent ; Adult ; Budesonide/therapeutic use ; Albuterol/therapeutic use ; Anti-Asthmatic Agents ; Ethanolamines/adverse effects ; Asthma/drug therapy ; Asthma/chemically induced ; Adrenal Cortex Hormones ; Administration, Inhalation ; Inflammation/drug therapy ; Formoterol Fumarate/therapeutic use ; Bronchodilator Agents/therapeutic use
    Chemical Substances Budesonide (51333-22-3) ; Albuterol (QF8SVZ843E) ; Anti-Asthmatic Agents ; Ethanolamines ; Adrenal Cortex Hormones ; Formoterol Fumarate (W34SHF8J2K) ; Bronchodilator Agents
    Language English
    Publishing date 2024-02-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2843237-X
    ISSN 2213-2201 ; 2213-2198
    ISSN (online) 2213-2201
    ISSN 2213-2198
    DOI 10.1016/j.jaip.2024.01.043
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