Journal of Asthma and Allergy最新文献

{"title":"Nasal Secretion Der p-Specific IgE as a Potential Non-Invasive Diagnostic Biomarker for House Dust Mite-Related Allergic Rhinitis: A Single-Center Cross-Sectional Diagnostic-Accuracy Study.","authors":"Fei Ye, Mei Ni, Qiuyan Shen, Zhihui Xu, Jiance Rong, Ji Wang, Hui Gan","doi":"10.2147/JAA.S639418","DOIUrl":"https://doi.org/10.2147/JAA.S639418","url":null,"abstract":"<p><strong>Background: </strong>Nasal secretion specific IgE (sIgE) may reflect local mucosal reactivity in allergic rhinitis (AR), but its diagnostic performance against nasal provocation remains uncertain.</p><p><strong>Objective: </strong>To evaluate nasal secretion Dermatophagoides pteronyssinus-specific IgE (Der p sIgE) for house dust mite (HDM)-related AR and its associations with nasal sensitivity and systemic sensitization.</p><p><strong>Methods: </strong>In this single-center cross-sectional diagnostic-accuracy study, 139 consecutive participants referred for suspected HDM-related AR underwent standardized HDM nasal provocation testing (NPT); after exclusion of 24 participants, 115 were included and classified as AR (positive NPT: Lebel score ≥ 5 with typical perennial rhinitis; n = 88) or non-AR controls (negative NPT, no typical history; n = 27). Nasal secretions were collected non-invasively with sterile cotton wool in one nostril for 15 min, and Der p sIgE was quantified in the eluate by chemiluminescent immunoassay (NOVEOS), with serum IgE on the same platform. Diagnostic accuracy was assessed by the area under the ROC curve (AUC).</p><p><strong>Results: </strong>Nasal Der p sIgE was higher in AR than controls (1.14 vs 0.03 kUA/L; P < 0.001); AUC was 0.84 (95% CI 0.76-0.91). At ≥ 0.1 kUA/L, sensitivity was 80.7% and specificity 66.7%; at ≥ 3.5 kUA/L, observed specificity was 100.0% (95% CI 87.5-100.0). Systemic HDM sensitization was present in 88/88 AR participants and 10/27 controls. Nasal Der p sIgE rose with nasal sensitivity (P < 0.001) and correlated with NPT score (<i>ρ</i> = 0.37), serum total IgE (<i>ρ</i> = 0.47), and serum Der p sIgE (<i>ρ</i> = 0.42; all q < 0.001).</p><p><strong>Conclusion: </strong>Non-invasively collected nasal Der p sIgE distinguished HDM-related AR from non-AR controls and tracked the intensity of local nasal reactivity. It may serve as a potential non-invasive adjunct to NPT, pending prospective validation.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"19 ","pages":"639418"},"PeriodicalIF":3.3,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pilot Study on Early-Phase Efficacy and Biomarker Analysis of Cervical Intralymphatic Immunotherapy for Seasonal Rhinoconjunctivitis.","authors":"Xu-De Zhang, Yu-Lin Wang, Tian Tian, Ting Wang, Hao Han, Wen-Kui Sun, Feng-Xia Liu","doi":"10.2147/JAA.S631998","DOIUrl":"10.2147/JAA.S631998","url":null,"abstract":"<p><strong>Background: </strong>Seasonal allergic rhinitis (SAR) imposes substantial morbidity, and intralymphatic immunotherapy (ILIT) offers a targeted approach for allergen delivery. However, short-term efficacy and associated biomarkers remain insufficiently characterized.</p><p><strong>Methods: </strong>Eight SAR patients received ultrasound-guided ILIT with 100 SQ-U allergen extracts injected into cervical lymph nodes. Assessments were performed at baseline, 1 month, and 2 months post-treatment, alongside eight age- and gender-matched healthy controls. Symptom severity was evaluated using Visual Analog Scale (VAS) and Combined Symptom and Medication Scores (CSMSs). Transcriptomic analysis of peripheral blood mononuclear cells (PBMCs) identified differentially expressed genes (DEGs), followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. Serum levels of specific and total IgE, together with 96 inflammatory proteins, were also quantified.</p><p><strong>Results: </strong>ILIT was associated with significant reductions in VAS and CSMSs at one month, with sustained improvement at two months during peak pollen season. Transcriptomic analysis identified 525 DEGs (p ≤ 0.05), reflecting a shift from Th2-dominant response toward Th1 and regulatory T-cell (Treg) phenotypes. Key genes included transcriptional regulator CREM, cytokine IFNG, signaling component TNFAIP3, and chemotaxis-related molecules (CXCR5, CCR4, CCR6, TNFSF14, CCL20), identifying a candidate multi-gene profile of early ILIT response. Serum proteomic analysis showed downregulated CCL20 and upregulated TNFRSF9, though these protein changes correlated weakly with tissue mRNA expression and showed limited between-group variation, indicating insufficient sensitivity for diagnostic or efficacy assessment.</p><p><strong>Conclusion: </strong>ILIT achieves rapid symptom relief in SAR, with transcriptomic and proteomic evidence of immune tolerance induction and innate immune activation. These biomarkers may support early efficacy monitoring, warranting confirmation in larger trials.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"19 ","pages":"631998"},"PeriodicalIF":3.3,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosing Calculations in Prescribing Sublingual Immunotherapy Drops Using Subcutaneous Immunotherapy Extracts: Implications for Dust Mite and Cat Immunotherapy.","authors":"Karna Gendo, Katherine Gilbert, Joshua Jacobs, Nancy Mozelsio, Roy A Orden, Allyson Tevrizian, Matthew Lodewick","doi":"10.2147/JAA.S639861","DOIUrl":"https://doi.org/10.2147/JAA.S639861","url":null,"abstract":"<p><p>Sublingual immunotherapy drops (SLIT-D) in the US commonly use extracts manufactured for subcutaneous immunotherapy (SCIT). Using a target daily major allergen dose together with the extract major allergen concentration allows calculation of the extract volume necessary for a maintenance SLIT vial. Although an optimal universal SLIT-D dose has not been established, published dosing recommendations provide practical benchmarks for illustrating these calculations. Using an illustrative target of 15 µg/day in an 8-mL vial, cat extract containing 20 µg/mL Fel d 1 would require 24 mL, whereas dust mite extract containing 60 µg/mL Der p 1 would require 8 mL. This Commentary presents a practical dose-estimation framework based on published allergen concentration data and highlights how lower major-allergen concentrations may constrain SLIT-D formulation.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"19 ","pages":"639861"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Urban Greenness and Air Pollution on Asthma Visits Among Children and Adolescents in Industrial and Non-Industrial Cities in Taiwan.","authors":"Hung-Ling Huang, Jia-Hong Tang, Chen-Yu Liu, Chau-Chyun Sheu, Ta-Chien Chan","doi":"10.2147/JAA.S614875","DOIUrl":"https://doi.org/10.2147/JAA.S614875","url":null,"abstract":"<p><strong>Background: </strong>Environmental factors such as air pollution and urban greenness are important in influencing pediatric asthma, yet their individual effects remain unclear across industrial and non-industrial settings. This study examined whether urban greenness modifies the link between air pollution and pediatric asthma in Kaohsiung (industrial) and Taipei (non-industrial), Taiwan, by highlighting differential environmental impacts on children's health.</p><p><strong>Methods: </strong>Daily pediatric asthma clinic encounters across target age strata were tracked from 111 clinics in Taipei (January 1, 2019-May 31, 2023) and 78 clinics in Kaohsiung (August 1, 2019-May 31, 2023). Multi-variable Poisson generalized additive mixed models evaluated criteria pollutant exposures alongside clinic-surrounding greenness (NDVI) across distributed lag structures.</p><p><strong>Results: </strong>PM₁₀, NO₂, and SO₂ increased daily ICD-10 asthma counts in younger children in Taipei, while SO₂ and NO₂ drove increases in Kaohsiung. Younger-child asthma risk rose at NDVI > 0.25 in Taipei, and at NDVI < 0.01 in Kaohsiung, where moderate NDVI (0.13-0.18) was protective. NDVI > 0.18 in both cities tracks with increased counts, possibly from pollutant trapping.</p><p><strong>Conclusion: </strong>Greenness modifies air pollution's association with pediatric asthma, with SO₂ and NO₂ most influential. Cautiously managing canopy density and reducing these pollutants could guide strategic urban planning to support child respiratory health.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"19 ","pages":"614875"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Parental Illness Uncertainty on Asthma Control in Children: The Chain Mediation of Resilience and Fear of Progression.","authors":"Huifang Xu, Min Cai","doi":"10.2147/JAA.S644617","DOIUrl":"https://doi.org/10.2147/JAA.S644617","url":null,"abstract":"<p><strong>Background: </strong>Parental illness uncertainty may affect pediatric asthma management, yet the psychological pathways linking parental uncertainty to child asthma control remain unclear. This study aimed to examine the chain mediating roles of resilience and fear of progression (FoP) in the association between parental illness uncertainty and childhood asthma control.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among 288 child-mother dyads attending follow-up visits at the pediatric outpatient clinic of a tertiary hospital in Fujian Province, China, between January 2025 and April 2026. Parental perceived illness uncertainty (PPUS), resilience, fear of progression (FoP), and childhood asthma control were measured. Chain mediation analysis was conducted using the PROCESS macro (Model 6) with 5000 bootstrap resamples.</p><p><strong>Results: </strong>Parental illness uncertainty was negatively correlated with asthma control (r = -0.575, p < 0.001). The chain mediation model showed acceptable fit (CFI = 0.952, TLI = 0.952, RMSEA = 0.074, SRMR = 0.032). The direct effect of illness uncertainty on C-ACT scores was significant (β = -0.361, 95% CI [-0.464, -0.259]), accounting for 62.8% of the total effect. Three significant indirect pathways were identified: through resilience alone (β = -0.158, 95% CI [-0.223, -0.092]; 27.4% of the total effect), through FoP alone (β = -0.036, 95% CI [-0.070, -0.003]; 6.3%), and the chain pathway through resilience and FoP (β = -0.020, 95% CI [-0.038, -0.001]; 3.4%). The total indirect effect was -0.214 (95% CI [-0.292, -0.136]), accounting for 37.2% of the total effect.</p><p><strong>Conclusion: </strong>Parental illness uncertainty was directly associated with poorer childhood asthma control and was indirectly associated with it through resilience and fear of progression. Strengthening parental resilience and reducing excessive fear of progression may be promising targets for family-centered interventions supporting pediatric asthma management.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"19 ","pages":"644617"},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Impact of Tezepelumab on Asthma Exacerbations, Healthcare Resource Utilization, and Costs in US Patients with Severe Asthma: CROSSROADS-1.","authors":"Santiago Zuluaga Sanchez, Jessica K DeMartino, Magdaliz Gorritz, Christopher S Ambrose, Rifat Tuly, Jean-Pierre Llanos, Chi-Chang Chen, Andrew W Lindsley, Lee Baylis, Weily Soong, Laren Tan","doi":"10.2147/JAA.S620862","DOIUrl":"10.2147/JAA.S620862","url":null,"abstract":"<p><strong>Purpose: </strong>Asthma affects 26 million individuals in the US, with severe cases driving high healthcare use and costs. Tezspire^TM (tezepelumab) has shown benefits in a Phase 4 real-world study, but real-world claims-based evidence is limited. This study evaluated the real-world effectiveness of tezepelumab by assessing changes in asthma exacerbations, healthcare use, and costs among persistent users.</p><p><strong>Methods: </strong>This retrospective cohort study used IQVIA's PharMetrics Plus claims database linked with Prognos and Quest data (12/17/2020 - 5/31/2024). Patients aged ≥12 years with severe asthma were included if they had continuous 12-month pre- and post-index medical and pharmacy enrollment, and ≥10 tezepelumab claims during 12-month follow-up. The index date was the first tezepelumab claim. Outcomes were compared pre- and post-index and included annualized asthma exacerbation rate (AAER), exacerbation-related healthcare resource utilization (HCRU), and costs. Subgroup analyses were conducted by prior biologic use, blood eosinophil count (BEC), serum IgE, and comorbidities.</p><p><strong>Results: </strong>Among 337 patients (mean age: 50.8 years; 78.0% female), 44.8% were biologic-naive and 55.2% were biologic-experienced. AAER decreased by 49.1% (95% CI: 43.5% to 54.2%; p<0.0001) following tezepelumab initiation, with greater reductions among biologic-naïve patients (55.7% [95% CI: 47.6% to 62.6%]; p<0.0001) and those with high pre-tezepelumab BEC (87.1% [95% CI: 63.5% to 95.5%] for ≥300 cells/µL; p<0.0001). Exacerbation-related healthcare use decreased, with mean inpatient, ED, and outpatient visits per patient declining from 0.14, 0.67, and 3.23 in the pre-index to 0.05, 0.37, and 1.63 in the post-index, respectively (p<0.0001 for all). Associated mean costs per patient were reduced: inpatient from $2,171 to $551 (p=0.0003), ED from $755 to $356 (p=0.0002), and outpatient from $933 to $477 (p<0.0001).</p><p><strong>Conclusion: </strong>Findings from this observational, retrospective analysis show substantial reductions in AAER, exacerbation-related HCRU and costs among patients treated with tezepelumab, with greater improvements observed among patients who were biologic-naive or with high BEC.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"19 ","pages":"620862"},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhaled Corticosteroid Use and Self-Reported Voice Problems in a Nordic Population-Based Cohort.","authors":"Sofia Ögefeldt, Greta Öhlund Wistbacka, Ellika Schalling, Henrik Johansson, Andrei Malinovschi, Christer Janson, Helena Backman, Mathias Holm, Ane Johannessen, Caroline Ahlroth Pind, Elin Dahlén, Össur Ingi Emilsson","doi":"10.2147/JAA.S638697","DOIUrl":"10.2147/JAA.S638697","url":null,"abstract":"<p><strong>Background: </strong>Voice problems are frequently reported among users of inhaled corticosteroids (ICS), but it remains unclear whether these problems reflect pharmacological effects, asthma, or comorbid chronic cough.</p><p><strong>Aim: </strong>This study aimed to examine the association between ICS use and voice problems in a Nordic population-based cohort, accounting for asthma symptoms and chronic cough. Secondary aims included dose-response patterns and differences by inhaler device type.</p><p><strong>Methods: </strong>Cross-sectional data from adults in Sweden and Norway participating in the Respiratory Health in Northern Europe IV study (RHINE, n=5,986) were linked to national prescription registers. ICS exposure during 2021 was quantified using annual filled defined daily doses (FDDD), calculated from dispensed prescriptions based on the corticosteroid content per inhalation and number of dispensed doses. Associations between self-reported voice problems and ICS use, asthma symptoms, and chronic cough were analyzed using logistic regression, adjusted for multiple confounders. Dose-response, exposure overlap, and inhaler device type were examined in secondary analyses.</p><p><strong>Results: </strong>Voice problems increased with higher ICS exposure, from 15.5% among non-users to 59.7% in the highest dose category. The dose-response pattern showed a steep increase at lower doses with attenuation at higher exposure levels. In adjusted analyses including ICS use, asthma symptoms and chronic cough, ICS use remained associated with voice problems (aOR 1.54 [1.13-2.10] for 1-150 FDDD; 2.88 [1.98-4.21] for 151-300 FDDD; and 3.00 [2.03-4.43] for >300 FDDD); as did asthma symptoms (aOR 2.31 [1.90-2.82] for one symptom; 3.14 [2.45-4.03] for ≥2 symptoms); and chronic cough (aOR 2.03 [1.67-2.46]). The highest prevalence was observed among participants with overlapping ICS use, asthma symptoms, and chronic cough. Inhaler device type did not affect voice problems, with reservation for low statistical power.</p><p><strong>Conclusion: </strong>ICS use, asthma symptoms, and chronic cough were independently associated with voice problems, with a clear dose-response for ICS, underscoring the need to consider both medication and respiratory symptoms in clinical assessment.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"19 ","pages":"638697"},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Umbilical Cord Blood Biomarkers for Early Risk Stratification of Childhood Asthma and Atopic Dermatitis: A Developmental and Critical Appraisal.","authors":"Haoyuan Li, Mengwei Wu, Peize Liu, Xu Li, Lili Zhi","doi":"10.2147/JAA.S640631","DOIUrl":"10.2147/JAA.S640631","url":null,"abstract":"<p><p>Asthma and atopic dermatitis (AD) often begin along developmental trajectories established before birth, making umbilical cord blood an attractive source of biomarkers for early risk stratification. However, association with later disease is not equivalent to clinically useful prediction. This critical narrative review evaluates five linked layers-baseline susceptibility, prenatal exposure windows, placental and cord blood mediator signals, postnatal modifiers, and phenotype-specific outcomes-through a clinical-prediction lens. Cord blood is uniquely positioned at birth and supports cellular, serologic, epigenetic, transcriptomic, and metabolic assessment before most postnatal infections and treatments. Its limitations include single-time-point sampling, maternal-blood contamination, uncertain analyte origin, delivery-related perturbation, cellular-composition effects, and matrix heterogeneity. Most studies of IgE, cytokines, chemokines, immune-cell markers, methylation, microRNA, and metabolic or exposure-related analytes report associations rather than validated prediction models; few test incremental value beyond a prespecified clinical model, calibration, clinical net benefit, or external validation. Current evidence therefore supports cord blood primarily as a mechanistic and risk-context biospecimen; no marker or panel is ready for routine screening. We provide a disease-specific, actionable go/no-go roadmap that moves candidates from a locked cord blood panel through incremental-value testing, external validation, feasibility assessment, and intervention-linked impact studies.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"19 ","pages":"640631"},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Upper Airway as a Treatable Trait: A United-Airway Framework for Biologic Selection in Asthma.","authors":"Pier-Valerio Mari, Simone Ielo, Lorenzo Carriera, Roberto Lipsi, Veronica Ojetti, Stefano Baglioni, Raffaele Scala, Eugenio De Corso","doi":"10.2147/JAA.S639138","DOIUrl":"10.2147/JAA.S639138","url":null,"abstract":"<p><p>The treatable traits approach reframes asthma management around measurable and modifiable factors rather than diagnostic labels, and it has become a cornerstone of the precision medicine model in chronic airway disease. Among the traits that shape asthma control, corticosteroid burden and treatment response, upper airway comorbidity is both prevalent and frequently under-recognised. Allergic rhinitis, chronic rhinosinusitis with and without nasal polyps, and olfactory dysfunction share anatomical, immunological and clinical links with the lower airway, and upper-airway comorbidities are increasingly considered in the management of severe asthma. However, their systematic characterisation as measurable, discrete treatable traits and their formal integration with lower-airway biomarkers at the point of biologic selection remain heterogeneous across clinical practice. In this narrative review, we propose a conceptual united-airway framework for the integrated assessment of upper- and lower-airway treatable traits in patients with asthma. The framework combines clinical phenotyping, validated assessment tools and local and systemic inflammatory biomarkers to characterise upper-airway disease and to support, rather than prescribe, biologic selection. We argue that type 2-high traits align with approved, biomarker-guided monoclonal antibodies, while upstream epithelial alarmin blockade has further expanded the therapeutic landscape. Tezepelumab, an anti-TSLP monoclonal antibody, is now approved for CRSwNP and does not require biomarker-based evidence of type 2 inflammation for treatment eligibility. We further consider how a treatable traits strategy helps disentangle uncontrolled from difficult-to-treat and severe asthma, how it supports corticosteroid-sparing, and how it can be operationalised within an integrated pulmonology-allergy-otolaryngology care pathway. Prospective studies are required to determine whether this conceptual approach improves biologic selection and patient-relevant outcomes across the united airway.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"19 ","pages":"639138"},"PeriodicalIF":3.3,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Unmet Needs in Uncontrolled Asthma Despite GINA Step 4/5 Treatment in Poland.","authors":"Maciej Kupczyk, Radosław Gawlik, Grażyna Bochenek, Iwona Poziomkowska-Gęsicka, Piotr Kuna, Rafał Dobek, Piotr Dąbrowiecki, Aleksandra Kucharczyk, Paweł J Ciesielczyk, Katarzyna Sosnowska, Adam Grabowicz","doi":"10.2147/JAA.S578348","DOIUrl":"10.2147/JAA.S578348","url":null,"abstract":"<p><strong>Background: </strong>Asthma is a heterogeneous chronic respiratory disease characterized by symptoms such as wheezing, shortness of breath, cough, and bronchial obstruction confirmed in spirometry. According to the Polish National Health Fund (NHF), in 2023 there were 2.07 million patients with asthma (International Classification of Diseases, ICD-10 codes J45, J46) in Poland. Despite guideline-based treatment recommended by the Global Initiative for Asthma (GINA) at steps 4 and 5, a substantial proportion of patients remain uncontrolled, leading to significant clinical and societal burden.</p><p><strong>Objective: </strong>This study aimed to identify the prevalence of uncontrolled asthma among adults receiving GINA step 4/5 therapy in Poland and to characterise the most common medical unmet needs (MUNs).</p><p><strong>Methods: </strong>We analyzed prescription data from the IQVIA™ Longitudinal Prescription Data (LRx) database covering approximately 55% of Polish pharmacies between November 2023 and October 2024. Adult patients (≥20 years) with GINA step 4/5 asthma were identified based on treatment patterns, including inhaled corticosteroids (ICS), long-acting beta-agonists (LABA), long-acting muscarinic antagonists (LAMA), oral corticosteroids (OCS), and biologics. MUNs were defined as: (1) annual OCS exposure >500 mg, (2) ≥2 exacerbations requiring high-dose OCS rescue medication, and (3) excessive short-acting beta-agonist (SABA) use (>3 packs/year).</p><p><strong>Results: </strong>Among 1.44 million adult asthma patients, 372,905 (26%) were classified as GINA step 4/5. Of these, 64,235 (17.2%) exhibited at least one MUN. High OCS exposure was most frequent (54% of MUN patients), followed by ≥2 exacerbations (38%) and SABA overuse (45%).</p><p><strong>Conclusion: </strong>Despite advanced therapy, a significant proportion of GINA step 4/5 asthma patients in Poland remain uncontrolled. Addressing these unmet needs requires optimized treatment strategies, improved patient education, and broader access to biologic therapies.</p>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"19 ","pages":"578348"},"PeriodicalIF":3.3,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}