Marc Massanari, PharmD: The History of Inflammation in Asthma

How has inflammation changed the scope of asthma care?

It actually goes back to the early 1990s when the first asthma guidelines came out. Those guidelines were written because patients were not receiving sufficient anti-inflammatory therapy, predominately inhaled corticosteroids. So, the guidelines were really written to inform clinicians how to better treat patients.

So it's been around for a really long time, but the tools to access and optimize the inhaled corticosteroid therapy never really existed. Physicians typically rely on traditional tests — spirometry — that measure airway obstruction but don't have the ability to measure airway inflammation. That's why exhaled nitrous oxide is so unique as a test. Nothing else could do that. Typically, the gold standard for measuring airway inflammation is to look at sputum eosinophils. As you know, sputum eosinophils is very difficult, and it's really only in special centers where they will get patients to produce eosinophils so they can analyze the presence of eosinophils in the sputum.

So this is a test they give at the bed side, it's non-invasive, it's very quick, so that's why I think it's impactful. It has a great indicative potential, because it's easy to use, it's inexpensive, and it's very accurate.