| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
ENFUMOSA: The European Network For Understanding Mechanisms Of Severe Asthma (investigators: B. Abraham, J.M. Antó, E. Barreiro, E.H.D. Bel, J. Bousquet, J. Castellsagud, P. chanez, B. Dahién, S.E. Dahién, 
. Dews, R. Djukanovic, L.M. Fabbri, G. Folkerts, M. Gaga, C. Gratziou, S.T. Holgate, P.H. Howarth, S.L. Johnston, F. Kanniess),
CORRESPONDENCE: S.T. Holgate, Respiratory Cell and Molecular Biology Research Division, Mail Point 810, Level D, Centre Block, Southampton General Hospital, Southampton, SO16 6YD, UK. Fax: 44 2380796960. E-mail: sth@soton.ac.uk
Keywords: asthma, atopy, clinical characteristics, disease severity, inflammatory biomarkers, sex-related disease
Received: July 19, 2001
Accepted May 29, 2003
This work was supported by a Concerted Action Grant for the European Union Framework IV Biomed Programme No. BMH4-96-1471, National Research Foundations in the participating countries, and unconditional support from several corporations including AstraZeneca, Bayer AG, Jaeger GmbH, Novartis Epidemiology, Pharmacia & Upjohn Diagnostics and SmithKline Beecham.
Since severe asthma is a poorly understood, major health problem, 12 clinical specialist centres in nine European countries formed a European Network For Understanding Mechanisms Of Severe Asthma (ENFUMOSA).
In a cross-sectional observational study, a total of 163 subjects with severe asthma were compared with 158 subjects whose asthma was controlled by low doses of inhaled corticosteroids (median dose of beclomethasone equivalents 666 µg). Despite being treated with higher doses of inhaled corticosteroids (median dose 1773 µg) and for a third of the severe asthmatics also being treated with regular, oral-steroid therapy (median daily dose 19 mg), the subjects with severe asthma met the inclusion criteria. The criteria required subjects to have undergone at least one asthma exacerbation in the past year requiring oral steroid treatment. Females dominated the severe asthma group (female/male ratio 4.4:1 versus 1.6:1 in the controlled asthmatics), and compared with controlled asthmatics, they had a predominantly neutrophilic inflammation (sputum neutrophils, 36 versus 28%) and evidence of ongoing mediator release but less atopy.
From these findings and other physiological and clinical data reported in this paper, it is suggested that severe asthma might be a different form of asthma rather than an increase in asthma symptoms. The findings prompt for longitudinal studies and interventions to define the mechanisms in severe asthma.
This article has been cited by other articles:
|
|
 |
|
  J B Morjaria, A J Chauhan, K S Babu, R Polosa, D E Davies, and S T Holgate The role of a soluble TNF{alpha} receptor fusion protein (etanercept) in corticosteroid refractory asthma: a double blind, randomised, placebo controlled trial Thorax, July 1, 2008; 63(7): 584 - 591. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R C Reddy Severe asthma: approach and management Postgrad. Med. J., March 1, 2008; 84(989): 115 - 120. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. L. Sorkness, E. R. Bleecker, W. W. Busse, W. J. Calhoun, M. Castro, K. F. Chung, D. Curran-Everett, S. C. Erzurum, B. M. Gaston, E. Israel, et al. Lung function in adults with stable but severe asthma: air trapping and incomplete reversal of obstruction with bronchodilation J Appl Physiol, February 1, 2008; 104(2): 394 - 403. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Shannon, P. Ernst, Y. Yamauchi, R. Olivenstein, C. Lemiere, S. Foley, L. Cicora, M. Ludwig, Q. Hamid, and J. G. Martin Differences in Airway Cytokine Profile in Severe Asthma Compared to Moderate Asthma Chest, February 1, 2008; 133(2): 420 - 426. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Lee, T. Haselkorn, L. Borish, L. Rasouliyan, B. E. Chipps, and S. E. Wenzel Risk Factors Associated With Persistent Airflow Limitation in Severe or Difficult-to-Treat Asthma: Insights From the TENOR Study Chest, December 1, 2007; 132(6): 1882 - 1889. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. E. Shaw, M. A. Berry, B. Hargadon, S. McKenna, M. J. Shelley, R. H. Green, C. E. Brightling, A. J. Wardlaw, and I. D. Pavord Association Between Neutrophilic Airway Inflammation and Airflow Limitation in Adults With Asthma Chest, December 1, 2007; 132(6): 1871 - 1875. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Hamelmann The rationale for treating allergic asthma with anti-IgE Eur. Respir. Rev., September 1, 2007; 16(104): 61 - 66. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. T. Holgate, D. E. Davies, R. M. Powell, P. H. Howarth, H. M. Haitchi, and J. W. Holloway Local genetic and environmental factors in asthma disease pathogenesis: chronicity and persistence mechanisms Eur. Respir. J., April 1, 2007; 29(4): 793 - 803. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Chanez and P. Godard Is difficult asthma still clinically meaningful? Eur. Respir. J., November 1, 2006; 28(5): 897 - 899. [Full Text] [PDF]
|
|
|
|
|
|
N. J. Roberts, D. S. Robinson, and M. R. Partridge How is difficult asthma managed? Eur. Respir. J., November 1, 2006; 28(5): 968 - 973. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Kikuchi, S. Kikuchi, T. Kobayashi, K. Hagiwara, Y. Sakamoto, M. Kanazawa, and M. Nagata Eosinophil Trans-Basement Membrane Migration Induced by Interleukin-8 and Neutrophils Am. J. Respir. Cell Mol. Biol., June 1, 2006; 34(6): 760 - 765. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. D. Pavord, S. S. Birring, M. Berry, R. H. Green, C. E. Brightling, and A. J. Wardlaw Multiple inflammatory hits and the pathogenesis of severe airway disease. Eur. Respir. J., May 1, 2006; 27(5): 884 - 888. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. H. van Veen, P. J. Sterk, R. Schot, S. A. Gauw, K. F. Rabe, and E. H. Bel Alveolar nitric oxide versus measures of peripheral airway dysfunction in severe asthma Eur. Respir. J., May 1, 2006; 27(5): 951 - 956. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Lancas, D. I. Kasahara, C. M. Prado, I. F. L. C. Tiberio, M. A. Martins, and M. Dolhnikoff Comparison of early and late responses to antigen of sensitized guinea pig parenchymal lung strips J Appl Physiol, May 1, 2006; 100(5): 1610 - 1616. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Wenzel and R. Covar Update in asthma 2005. Am. J. Respir. Crit. Care Med., April 1, 2006; 173(7): 698 - 706. [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Berry, B. Hargadon, M. Shelley, D. Parker, D. E. Shaw, R. H. Green, P. Bradding, C. E. Brightling, A. J. Wardlaw, and I. D. Pavord Evidence of a Role of Tumor Necrosis Factor {alpha} in Refractory Asthma N. Engl. J. Med., February 16, 2006; 354(7): 697 - 708. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. C. Erzurum Inhibition of Tumor Necrosis Factor {alpha} for Refractory Asthma N. Engl. J. Med., February 16, 2006; 354(7): 754 - 758. [Full Text] [PDF]
|
|
|
|
 |
|
 B. D. Medoff, A. M. Tager, R. Jackobek, T. K. Means, L. Wang, and A. D. Luster Antibody-antigen interaction in the airway drives early granulocyte recruitment through BLT1 Am J Physiol Lung Cell Mol Physiol, January 1, 2006; 290(1): L170 - L178. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P H Howarth, K S Babu, H S Arshad, L Lau, M Buckley, W McConnell, P Beckett, M Al Ali, A Chauhan, S J Wilson, et al. Tumour necrosis factor (TNF{alpha}) as a novel therapeutic target in symptomatic corticosteroid dependent asthma Thorax, December 1, 2005; 60(12): 1012 - 1018. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. M. Gueders, M. Balbin, N. Rocks, J.-M. Foidart, P. Gosset, R. Louis, S. Shapiro, C. Lopez-Otin, A. Noel, and D. D. Cataldo Matrix Metalloproteinase-8 Deficiency Promotes Granulocytic Allergen-Induced Airway Inflammation J. Immunol., August 15, 2005; 175(4): 2589 - 2597. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Le Moual, V. Siroux, I. Pin, F. Kauffmann, S. M. Kennedy, and on behalf of the Epidemiological Study on the Gene Asthma Severity and Exposure to Occupational Asthmogens Am. J. Respir. Crit. Care Med., August 15, 2005; 172(4): 440 - 445. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Wenzel Severe Asthma in Adults Am. J. Respir. Crit. Care Med., July 15, 2005; 172(2): 149 - 160. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Gea, E. Barreiro, and C. Sanjuas From the authors Eur. Respir. J., March 1, 2005; 25(3): 582 - 582. [Full Text] [PDF]
|
|
|
|
|
|
R. Varraso, V. Siroux, J. Maccario, I. Pin, F. Kauffmann, and on behalf of the Epidemiological Study on the Gene Asthma Severity Is Associated with Body Mass Index and Early Menarche in Women Am. J. Respir. Crit. Care Med., February 15, 2005; 171(4): 334 - 339. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Mauad, L. F. F. Silva, M. A. Santos, L. Grinberg, F. D. C. Bernardi, M. A. Martins, P. H. N. Saldiva, and M. Dolhnikoff Abnormal Alveolar Attachments with Decreased Elastic Fiber Content in Distal Lung in Fatal Asthma Am. J. Respir. Crit. Care Med., October 15, 2004; 170(8): 857 - 862. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Wenzel Phenotypes in Asthma: Useful Guides for Therapy, Distinct Biological Processes, or Both? Am. J. Respir. Crit. Care Med., September 15, 2004; 170(6): 579 - 580. [Full Text] [PDF]
|
|
|
|
|
|
A. ten Brinke, A. H. Zwinderman, P. J. Sterk, K. F. Rabe, and E. H. Bel "Refractory" Eosinophilic Airway Inflammation in Severe Asthma: Effect of Parenteral Corticosteroids Am. J. Respir. Crit. Care Med., September 15, 2004; 170(6): 601 - 605. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. L. Colice Categorizing Asthma Severity: An Overview of National Guidelines Clin. Med. Res., August 1, 2004; 2(3): 155 - 163. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Gaga Fixed obstruction in severe asthma: not just a matter of time Eur. Respir. J., July 1, 2004; 24(1): 8 - 10. [Full Text] [PDF]
|
|
|
|
|
|
P.G. Gibson and J.L. Simpson The European Network For Understanding Mechanisms Of Severe Asthma study Eur. Respir. J., March 1, 2004; 23(3): 492 - 492. [Full Text] [PDF]
|
|
|
|
|
|
S.T. Holgate and S-E. Dahlen From the Authors Eur. Respir. J., March 1, 2004; 23(3): 492 - 492. [Full Text] [PDF]
|
|
|
|
|
|
P. Maestrelli Natural History of Adult-Onset Asthma: Insights from Model of Occupational Asthma Am. J. Respir. Crit. Care Med., February 1, 2004; 169(3): 331 - 332. [Full Text] [PDF]
|
|
|
|
|
|
S.E. Wenzel A different disease, many diseases or mild asthma gone bad? Challenges of severe asthma Eur. Respir. J., September 1, 2003; 22(3): 397 - 398. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
