Stakeholder Opinions: Asthma Phenotypes A changing paradigm

Publication Date	March 2007
Publisher	Datamonitor
Product Type	Report
Pages	178
ISBN Number	not applicable
Product Code	DAT04842

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Summary

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

Content

Chapter 1 Executive Summary
- Scope of the report
- Contributing experts
- Datamonitor insight into asthma phenotypes
Chapter 2 Asthma Background And Epidemiology
- Disease definition
- Causes of asthma: environment and genes
- Etiology
- Disease classification and phenotypes
- Phenotypes
- Prevalence
Chapter 3 Asthma Diagnosis And Treatment Options
- Presentation and diagnosis
- Treatment options and guidelines
- Bronchodilators
- Beta2-agonists
- Anticholinergics
- Combination beta2-agonist/anticholinergic
- Anti-inflammatories
- Inhaled corticosteroids
- Systemic corticosteroids
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- ICS/LABA combinations
- Biologicals
- Future trends in asthma treatment
- Asthma biomarkers
Chapter 4 Clinical Or Physiological Phenotypes
- Severity-defined asthma
- Prevalence
- Refractory asthma
- Pathobiology
- The refractory asthma patient
- Prevalence
- Treatment
- The exacerbation-prone subtype of refractory asthma
- Chronic airflow obstruction in asthma
- Pathobiology
- The asthma patient with chronic airflow obstruction
- Prevalence
- Treatment
- Asthma defined by age of onset
- The early- versus late-onset patient
- Treatment
- Nocturnal asthma
- Pathobiology
- Prevalence
- Treatment
- Viral infections during childhood
- Asthma and obesity
Chapter 5 Phenotypes Related To Certain Triggers
- Environmental allergens
- Pathobiology
- The allergic march
- The allergic versus non-allergic asthma patient
- Prevalence
- Treatment
- Immunotherapy
- Aspirin- and NSAID-sensitive asthma
- The aspirin-sensitive asthma patient
- Prevalence
- Treatment
- Occupational allergens or irritants
- Prevalence
- Treatment
- Menses-related asthma
- Exercise-induced asthma
- Treatment
Chapter 6 Inflammatory Phenotypes
- Eosinophilic inflammatory asthma
- Prevalence
- Neutrophilic inflammatory asthma
- The neutrophilic asthma phenotype
- Prevalence
- Pauci-granulocytic inflammatory asthma
- Prevalence
Chapter 7 Asthma Phenotypes In The Future
- Why and how could we use phenotypes?
- Phenotypes and endpoints
- New endpoints
- The battle over asthma control
- Phenotypes and biomarkers
- How can we progress the identification of phenotypes?
- Which phenotype should we target first?
- Case study 1: Xolair (omalizumab) in severe allergic asthma
- Case study 2: Immunotherapy in severe allergic asthma
- Case study 3: an anti-inflammatory drug in neutrophilic asthma
- REFERENCES
- Disclaimer
List Of Tables
- Table 1: Asthma prevalence and diagnosed population by country and age, 2007
- Table 2: Diagnosed asthma by country and severity for children and adults/elderly, 2007
- Table 3: Prevalence of severe/refractory asthma by country, 2007
- Table 4: Prevalence of exacerbation-prone severe/refractory asthma by country, 2007
- Table 5: Prevalence of chronic airflow obstruction in diagnosed adult/elderly and pediatric asthma population by country (000s), 2007
- Table 6: Prevalence of diagnosed asthma patients with nocturnal symptoms in the seven major markets (million), 2007
- Table 7: The prevalence of allergic and non-allergic asthma in the seven major markets, 2007 ('000)
- Table 8: Prevalence of allergic asthma according to severity in the seven major markets, 2007 ('000)
- Table 9: Range of prevalence of diagnosed asthma patients with aspirin/NSAID sensitive asthma, 2007
- Table 10: Prevalence of occupational asthma in the diagnosed adult asthma population, 2007
- Table 11: Prevalence of diagnosed asthma patients with predominantly eosinophilic inflammation, 2007 ('000)
- Table 12: Prevalence of diagnosed asthma patients with predominantly neutrophilic inflammation, 2007
- Table 13: Prevalence of different inflammatory phenotypes in diagnosed asthmatic children, adults and elderly, 2007 ('000)
- Table 14: Marketed and pipeline therapies in eosinophilic and neutrophilic inflammation
List Of Figures
- Figure 1: Basic etiology of asthma
- Figure 2: Levels of asthma control according to the GINA guidelines
- Figure 3: Early/childhood onset phenotypes
- Figure 4: Late/adult onset phenotypes
- Figure 5: Percentage of asthma patients who experience daily or weekly symptoms by age, 2004
- Figure 6: Management approach based on asthma control
- Figure 7: Novel asthma therapies are moving towards targeted therapy
- Figure 8: The role of biomarkers related to asthma therapy
- Figure 9: Overview of clinical or physiological phenotypes
- Figure 10: Classification of asthma by clinical, pretreatment features
- Figure 11: ATS workshop consensus for definition of refractory asthma
- Figure 12: A normal airway compared to the process in airway remodeling
- Figure 13: Early-onset versus late-onset asthma
- Figure 14: Circadian alterations in lung function in healthy subjects and patients with nocturnal asthma
- Figure 15: Viral infections have been implicated in at least three ways with asthma pathogenesis
- Figure 16: Overview of phenotypes related to certain triggers
- Figure 17: The early and late allergic response
- Figure 18: Proposed systemic inflammatory mechanisms linking the upper and lower airways
- Figure 19: The allergic march
- Figure 20: Prevalence of aspirin-sensitive asthma according to studies versus key opinion leaders (KOLs)
- Figure 21: Categories and subcategories of occupational asthma
- Figure 22: Overview of inflammatory phenotypes
- Figure 23: Characteristics of eosinophil-positive (+) and eosinophil-negative (-) severe asthma
- Figure 24: The complex relation between various triggers of airway inflammation and the diseases associated with them
- Figure 25: Exacerbations in patients following guideline-therapy and sputum-identification therapy
- Figure 26: How can we progress the identification of asthma phenotypes?
- Figure 27: The reaction of neutrophils to CXC chemokines in the early phase of inflammation
- Figure 28: The difference between potential US peak sales and actual US sales of Xolair in allergic asthma
- Figure 29: Possible US peak sales of Grazax in allergic asthma
- Figure 30: Possible US peak sales of a novel anti-inflammatory in neutrophilic asthma