Personalized Medicine in Severe Asthma: From Biomarkers to Biologics.

Severe asthma is a complex and heterogeneous clinical condition presented as chronic inflammation of the airways. Conventional treatments are mainly focused on symptom control; however, there has been a shift towards personalized medicine. Identification of different phenotypes driven by complex pathobiological mechanisms (endotypes), especially those driven by type-2 (T2) inflammation, has led to improved treatment outcomes. Combining biomarkers with T2-targeting monoclonal antibodies is crucial for developing personalized treatment strategies. Several biological agents, including anti-immunoglobulin E, anti-interleukin-5, and anti-thymic stromal lymphopoietin/interleukin-4, have been approved for the treatment of severe asthma. These biological therapies have demonstrated efficacy in reducing asthma exacerbations, lowering eosinophil count, improving lung function, diminishing oral corticosteroid use, and improving the quality of life in selected patients. Severe asthma management is undergoing a profound transformation with the introduction of ongoing and future biological therapies. The availability of novel treatment options has facilitated the adoption of phenotype/endotype-specific approaches and disappearance of generic interventions. The transition towards precision medicine plays a crucial role in meticulously addressing the individual traits of asthma pathobiology. An era of tailored strategies has emerged, allowing for the successful targeting of immune-inflammatory responses that underlie uncontrolled T2-high asthma. These personalized approaches hold great promise for improving the overall efficacy and outcomes in the management of severe asthma. This article comprehensively reviews currently available biological agents and biomarkers for treating severe asthma. With the expanding repertoire of therapeutic options, it is becoming increasingly crucial to comprehend the influencing factors, understand the pathogenesis, and track treatment progress in severe asthma.

Association between Shock Index and Emergency Department Cardiac Arrest.

BACKGROUND: In the emergency department (ED), early identification of patients at risk of cardiac arrest is paramount, especially in the context of overcrowding. The shock index (SI) is defined as the ratio of heart rate to systolic blood pressure. It is a tool used for predicting the prognosis of critically ill and injured patients. In this study, we have discussed the relationship between SI and cardiac arrest in the ED. METHODS: Patients who experienced cardiac arrest in the ED were classified into two groups, SI ≥ 0.9 and < 0.9, according to their triage vital signs. The association between SI ≥ 0.9 and in-hospital mortality was analyzed in five different etiologies of cardiac arrest, including hypoxia, cardiac cause, bleeding, sepsis, and other metabolic problems. RESULTS: In total, 3,313 patients experienced cardiac arrest in the ED. Among them, 1,909 (57.6%) had a SI of ≥0.9. The incidence of SI ≥ 0.9 in the five etiologies was 43.5% (hypoxia), 58.1% (cardiac cause), 56.1% (bleeding), 58.0% (sepsis), and 65.5% (other metabolic problems). SI was associated with in-hospital mortality (adjusted odds ratio (aOR), 1.6; 95% confidence interval (CI), 1.5-1.8). The aOR (CI) in the five etiologies was 1.3 (1.1-1.6) for hypoxia, 1.8 (1.6-2.1) for cardiac cause, 1.3 (0.98-1.7) for bleeding, 1.3 (1.03-1.6) for sepsis, and 1.9 (1.5-2.1) for other metabolic problems. CONCLUSION: More than half of the patients who experienced cardiac arrest in the ED had a SI ≥ 0.9. The SI was also associated with in-hospital mortality after cardiac arrest in the ED. SI maybe used as a screening tool to identify patients at risk of cardiac arrest in the ED and a predictor of mortality in those experiencing cardiac arrest in the ED.

Increased Risk of Mesenteric Ischemia in Patients With Alcohol Use Disorder: A Population-Based Retrospective Cohort Study.

OBJECTIVE: To investigate the association between alcohol use disorder and the risk of mesenteric ischemia by conducting a population-based retrospective cohort study. PATIENTS AND METHODS: The present study enrolled 62,115 patients hospitalized for alcoholic intoxication between January 1, 1999, and December 31, 2009, and matched each of them with 4 comparison patients with similar mean age and sex ratios. We determined the cumulative incidences and adjusted hazard ratios (aHRs) of mesenteric ischemia. RESULTS: A significant association was observed between alcoholic intoxication and mesenteric ischemia (aHR, 5.21; 95% CI, 4.36-6.23; P<.0001) after adjustment for age, sex, and comorbidity history of hypertension, hyperlipidemia, diabetes, atrial fibrillation, stroke, heart failure, chronic renal disease, ischemic heart disease, chronic obstructive pulmonary disease, and cirrhosis. After less than 1 year of follow-up, the incidence rate of mesenteric ischemia in the alcoholic intoxication group was approximately 9.38-fold higher than that in the comparison patients (aHR, 9.38; 95% CI, 5.52-15.9; P<.0001). CONCLUSION: Physicians should carefully consider the alcohol history of patients who complain of abdominal pain and respond poorly to treatment, because alcohol use disorder is a risk factor for mesenteric ischemia, a surgical emergency.