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Aug 18 / Springer Healthcare

American Thoracic Society 2020 Annual Meeting In-depth Report: Asthma


In this in-depth report, sessions covering the diagnosis and management of asthma are summarised.

American Thoracic Society ATS 2020 Annual Meeting

5th – 10th August, 2020

In-Depth Report: Asthma

Originally scheduled to take place in Philadelphia in May, the 2020 congress of the American Thoracic Society (ATS) was held virtually between 5th–10th August. Welcoming delegates to the congress, ATS President, Juan Celedón, and Immediate Past President, James Beck, explained that ATS 2020 Virtual would feature a rich and diverse platform of online content, including a blend of both pre-recorded and live sessions.

As always, the congress’s cutting-edge clinical and scientific programme offered delegates the opportunity to deep dive into important topics and the latest advancements in pulmonary, critical care and sleep medicine. In this in-depth report, sessions covering the diagnosis and management of asthma are summarised.


Clinical Year in Review: Asthma


The total projected direct and indirect costs due to controlled asthma will be high over the next 2 decades in the USA.

Total projected direct and indirect excess costs due to controlled asthma over the next 2 decades in the USA.

The annual Clinical Year in Review symposia aimed to provide concise summaries of some of the most impactful clinical research publications across different areas of pulmonary and critical care medicine. Sunita Sharma, Aurora, USA, highlighted the most important and influential publications in the field of asthma. A key health economics study in the USA has predicted a large burden of uncontrolled asthma over the next 20 years in both adolescent and adult populations if no paradigm shift occurs in contemporary asthma management.

In the area of risk reduction, results from the 6-year follow-up of a randomised, double-blind, placebo-controlled trial of antenatal vitamin D showed no impact on asthma prevention, recurrent wheeze or the risk of other atopic conditions at age 6. Better insight into the management of mild asthma, particularly in patients who experience exacerbations, has been the focus of increasing clinical interest, Dr Sharma explained. The novel START study showed that as-needed budesonide-formoterol was associated with a decreased risk of asthma exacerbations compared to both albuterol as-needed and budesonide maintenance therapy. New research looking at optimal step-up therapy in patients with poorly controlled asthma also found that addition of a long-acting beta agonist (LABA) produced a superior response compared with increasing the dose of inhaled corticosteroid (ICS) in both adolescents and adults. In the severe asthma arena, 2020 saw the publication of updated joint ERS/ATS management guidelines. These clinical recommendations reflect the increasing use of biologic agents in severe disease and establish biomarker cut-off points to guide treatment decision-making.

“Around 20% of the direct costs of asthma can potentially be prevented by achieving asthma control in the population.”

Sunita Sharma, Aurora, USA

Paediatric Year in Review of Asthma

As part of the Paediatric Year in Review session, Louise Fleming, London, UK, provided an update on current state-of-the-art in childhood asthma management. An open-label pragmatic equivalence trial reflective of real-life clinical practice showed that control can be maintained with intermittent, symptom-based ICS in children with mild asthma, resulting in significantly lower overall ICS exposure. According to results from a recent strand of the global SABINA programme, overuse of short-acting beta agonists (SABA) in asthma (defined as ≥3 canisters per year) was linked to increased risk of exacerbations and mortality - a finding likely to be just as pertinent for adolescents and children as adults, noted Dr Fleming. Other data have demonstrated that, in contrast to adults, adolescents and Caucasian children, children of black heritage respond to stepped increases in ICS dose. In the acute management of asthma, a recent meta-analysis uncovered limited evidence to support the efficacy of macrolides. One of the major headlines in severe asthma for 2020 was FDA approval of the first targeted biologic - the anti-interleukin (IL)-5 antibody mepolizumab for paediatric eosinophilic asthma. Subgroup analysis of the 37 adolescent patients from pivotal trials showed a rate ratio of exacerbations/year in favour of mepolizumab versus placebo, although the corresponding confidence intervals were large. Other publications in the paediatric arena have highlighted the importance of adopting a collative approach when using biologics for severe asthma and the adverse impact of childhood asthma on both educational and health outcomes.


Integrative Genomics Strategies for Complex Respiratory Diseases

A deluge of omics data is currently being generated with the aim of identifying novel biological mechanisms that underpin respiratory diseases. Blanca Himes, Philadelphia, USA, outlined how integrative analyses of omics data can increase understanding of asthma drug response - particularly to glucocorticoids which act by directly altering gene expression. Dr Himes explained that the integration of publically available multi-omics data from datasets such as REALGAR (REducing Associations by Linking Genes And omics Results) can provide helpful insights to focus the functional validation of asthma pharmacogenetic study results. Existing evidence from a number of different omics sources indicates that SNP variants in or near BIRC3 may influence response to ICS. However, further functional studies will be required to confirm this.

Omics approaches measure different levels of biological information

Omics approaches can provide insights to focus the functional validation of asthma pharmacogenetic study results.

The omics approaches that measure different levels of biological information.


Evolving Knowledge of the Effect of Cannabis and Cannabinoids on the Lung

Despite burgeoning use of cannabis for medical and recreational use, little scientific evidence exists for the short- or long-term impact of cannabis on lung health. This timely session explored basic, clinical and translational research in the field. Asthma and cannabis use were described by Ajay Nayak, Philadelphia, USA, as a ‘double-edged sword’. The term cannabis itself is used very loosely and different components in different contexts of exposure can serve unique pathological or pathophysiological purposes. For example, some studies have indicated potential allergens in cannabis may exacerbate underlying asthma. The ability of cannabinoids to modulate bronchomotor tone also raises questions about possible effects on asthma development and exacerbation, although current evidence is inconclusive. Conversely, the bronchodilatory actions of cannabinoids, particularly those that signal through CB-1 receptors, and the immunomodulatory effects mediated via CB2 receptors provides new avenues for the development of asthma therapeutics. Dr Nayak explained that the challenge going forward will be to establish where cannabis fits on either side of this duality so that we can harness its value as a source of medicine while eliminating the risks.


Clinical Practice 2020: Effectively Learning, Teaching and Sharing Medical Information

This year’s ATS President’s symposium, introduced by W Graham Carlos, Indianapolis, USA, explored the evolution of medical learning and examined the impact of the recent explosion of electronic information. Its aim was to help clinicians engage with and appropriately analyse medical information in the digital age by providing tools to navigate social media, objectively assess online data quality and leverage the educational opportunities of virtual learning. Harnessing the power of medical information is important across all areas of respiratory medicine, with particular relevance in the asthma arena where patient engagement and education remains vital to optimise disease control. Social media and digital tools are also assuming increasing importance in asthma management, fueled by increasing use of smart devices and digital capture of disease information for treatment decision-making and monitoring.

John Hansen-Flaschen, Philadelphia, USA, explored the evolution of the medical library from past to present. He highlighted Google Scholar, Kopernio, ReadCube Papers and Dimension.ai as particularly useful tools for accessing today’s medical literature. From paper to streamlined digital resources, Dr Hansen-Flaschen explained that the revolution in library science and technology which has unfolded over the last 40 years has helped fuel extraordinary advances in biomedicine. This innovation continues a blistering pace, making it essential for clinicians to stay fully up-to-date in medical information technology.

Social media can be educational, fun and even inspiring for respiratory physicians, said Lekshmi Santhosh, San Francisco, USA, citing key positives as:

  • Extending the reach of research
  • Catching up on medical literature
  • Networking with experts in the field
  • Following conversations on new articles, conferences and chats
  • Seizing opportunities for branding, self-promotion and academic advancement

Rapid evolution in the landscape of social media has also become increasing evident since the Covid-19 pandemic. Whichever route of engagement is taken, it is important to always consume, promote, discuss and create content safely. Consider biases, expertise and experiences/perspectives when accessing content, stressed Dr Santhosh.

“What does the future hold for exchanging medical information?” asked Jess Mandel, La Jolla, USA, as he reviewed the history and evolution of medical education. Greater access to information and data of all types has served to progressively reshape both medical education and clinical practice. These trends will likely accelerate in the future coupled with rapid growth and improvement of data analytic tools, while old models of simple information transmission (e.g. lectures) become less relevant. In terms of clinical care, Dr Mandel suggested that the future may resemble a ‘physician-computer dyad’ - exploiting key tools such as artificial intelligence (notably machine learning and deep learning for image interpretation), personalised big data and optimisation of the person-machine interface.

Nitin Seam, Bethesda, USA, Editor-in-Chief of the newest ATS journal ‘ATS Scholar’ presented his vision of the modern medical journal in today’s digital world. Modern medical journals should provide high-quality peer-reviewed content while remaining mindful of readers’ changing consumption habits. It is important to focus on what’s relevant to the community of readers, noted Dr Seam, and reflect the diverse communities served. Journals also need to provide content across a broad range of platforms. Offerings from ATS Scholar in this field include peer-reviewed educational videos, community commentaries from the front-line of clinical care, podcasts to discuss and contextualise journal articles and targeted social media activity to promote and disseminate journal content.


Closing Remarks

Looking ahead to next year, ATS 2021 is due to take place in San Diego, USA, from 14th–19th of May.


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