ERS 2022: Airway Diseases Precision Medicine for Asthma, Chronic Obstructive Pulmonary Disease, and Chronic Cough: New Drugs, Biomarkers, and Approaches

In this session, an individual's ageing patterns and how these can impact future clinical outcomes, identification and treatment options for people with chronic cough, relevant biomarkers and how to apply them in clinical practice were discussed.

The first talk focused on GETomics and integrating the time axis in understanding COPD. COPD can be understood as the potential result of the accumulation of gene-environment (G X E) interactions encountered by an individual over the life course. Integration of a time axis in pathogenic models of COPD is necessary because the biological responses to and clinical consequences of different exposures may vary according to the age of an individual at which a given gene-environment interaction occurs and the cumulative history of previous gene-environment interactions.

A GETomics approach to human health:

• The same G X E interaction at different ages may have a different outcome (development, ageing, repair capacity).
• The outcome of any G X E interaction not only depends on the age of the individual at which it occurs but also on the cumulative history of previous events and the biological response they elicited: epigenetics and immune response.¹

There is a range of lung-function trajectories throughout life. Therefore, Spirometry assessed during childhood, adolescence, and early and late adulthood can be a reproducible, non-invasive, safe, and affordable global health marker to identify individuals in the general population at risk of respiratory and non-respiratory NCDs.

The next talk discussed the similarities and differences between a cough and chronic pain. Cough and pain are both fundamental defensive processes. They have similar neuronal pathways and can profoundly impact the quality of life when dysfunctional. Refractory chronic cough is probably more similar to neuropathic pain. It shares similar clinical and pathophysiological features, responds to similar therapeutics, and exhibits substantial placebo effects.

The next talk discussed the role of biomarkers of airway diseases in clinical practice.

• After careful consideration, the task force suggests measuring FeNO as part of the diagnosis of asthma.
•  The gold standard approach for assessing the inflammatory phenotype of asthma is induced sputum.
• It is essential to recognize that a subset of eosinophilic asthmatics has eosinophil granules, rather than intact eosinophils, present in sputum, which may result in misclassifying as non-eosinophilic.
• Sputum eosinophils and blood eosinophils are surrogate biomarkers of type 2 asthma. They can help predict exacerbations, lung function decline, and poor control.
• Factors associated with lung function decline in moderate asthma include higher FeNO, high eosinophil sputum numbers, and in severe asthma, FeNO >20 ppb and high variability in sputum eosinophils.

In asthmatics with at least a 5-year, follow-up, increased blood eosinophil count over time is a risk factor for lung function decline.

Assessment methods of airway mucus function and the associated treatment in asthma and COPD have been discussed in this talk. Validated questionnaires have been developed to obtain semi-quantitative scales that can be used in clinical trials and daily clinical practice. Keeping in mind the advantages and disadvantages and the potential biases and difficulties associated with sampling human airway mucus, the "direct analysis" of mucus remains a valuable and varied source of information. Current treatment approaches in asthma and COPD include smoking cessation, azithromycin and other antibiotics, corticosteroids and T2 targeting monoclonal antibodies, bronchodilators, physiotherapy, and other physical measures, CFTR and epithelial sodium channel (ENaC) modulators, and mucolytics like N-acetyl cysteine and hypertonic saline.

European Respiratory Society (ERS) International Congress 2022, 3^rd-6^th Sept. 2022, Barcelona