Publications
297 results found
Babalis D, Saglani S, Cornelius V, 2019, To fund or not to fund a paediatric severe asthma trial: that is the question, Publisher: BMC
Selby L, Jamalzadeh A, Hall P, et al., 2019, Adherence, airway inflammation and adrenal suppression in children with asthma, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Selby L, Saglani S, Bush A, et al., 2019, Assessment of adrenal function using low and standard dose synacthen tests in a cohort of paediatric asthma patients, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Grime C, Garbato G, Rosenthal M, et al., 2019, Low prevalence of obstructive sleep apnoea in paediatric severe therapy resistant asthma, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Lloyd CM, Saglani S, 2019, Opening the Window of Immune Opportunity: Treating Childhood Asthma, TRENDS IN IMMUNOLOGY, Vol: 40, Pages: 786-798, ISSN: 1471-4906
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- Citations: 15
Saglani S, Fleming L, Sonnappa S, et al., 2019, Advances in the aetiology, management, and prevention of acute asthma attacks in children (vol 3, pg 354, 2019), LANCET CHILD & ADOLESCENT HEALTH, Vol: 3, Pages: E13-E13, ISSN: 2352-4642
Oksel C, Granell R, Haider S, et al., 2019, Distinguishing wheezing phenotypes from infancy to adolescence: a pooled analysis of five birth cohorts, Annals of the American Thoracic Society, Vol: 16, Pages: 868-876, ISSN: 2329-6933
RATIONALE: Pooling data from multiple cohorts and extending the time-frame across childhood should minimize study-specific effects, enabling better characterization of the childhood wheezing. OBJECTIVE: To analyze wheezing patterns from early childhood to adolescence using combined data from five birth cohorts. METHODS: We used latent class analysis to derive wheeze phenotypes among 7719 participants from five birth cohorts with complete report of wheeze at five time-periods. We tested the association of derived phenotypes with late asthma outcomes and lung function, and investigated the uncertainty in phenotype assignment. RESULTS: We identified five phenotypes: Never/Infrequent wheeze (52.1%), Early-onset pre-school remitting (23.9%), Early-onset mid-childhood remitting (9%), Persistent (7.9%) and Late-onset wheeze (7.1%). Compared to the Never/infrequent wheeze, all phenotypes had higher odds of asthma and lower FEV1 and FEV1/FVC in adolescence. The association with asthma was strongest for Persistent wheeze (adjusted odds ratio 56.54, 95%CI 43.75-73.06). We observed considerable within-class heterogeneity at individual level, with 913 (12%) children having low membership probability (<0.60) of any phenotype. Class membership certainty was highest in Persistent and Never/infrequent, and lowest in Late-onset wheeze (with 51% of participants having membership probabilities<0.80). Individual wheezing patterns were particularly heterogeneous in Late-onset wheeze, while many children assigned to Early-onset pre-school remitting class reported wheezing at later time points. CONCLUSIONS: All wheeze phenotypes had significantly diminished lung function in school-age, suggesting that the notion that early-life episodic wheeze has a benign prognosis may not be true for a proportion of transient wheezers. We observed considerable within-phenotype heterogeneity in individual wheezing patterns.
Nagakumar P, Puttur F, Gregory LG, et al., 2019, Pulmonary type2 innate lymphoid cells in paediatric severe asthma: phenotype and response to steroids, European Respiratory Journal, Vol: 54, Pages: 1-14, ISSN: 0903-1936
Children with severe therapy resistant asthma (STRA) have poor control despite maximal treatment, while those with difficult asthma (DA) have poor control from failure to implement basic management including adherence to therapy. Although recognised as clinically distinct, the airway molecular phenotype, including the role of ILCs and their response to steroids in DA and STRA is unknown.Immunophenotyping of sputum and blood ILCs and T cells from STRA, DA and non-asthmatic controls was undertaken. Leukocytes were analysed longitudinally pre and post intramuscular triamcinolone in children with STRA. Cultured ILCs were also evaluated to assess steroid responsiveness in vitroAirway eosinophils, Th2 cells and ILC2s were significantly higher in STRA patients compared to DA and disease controls, while IL-17+ lymphoid cells were similar. ILC2s and Th2 cells were significantly reduced in vivo following intramuscular triamcinolone and in vitro with steroids. Asthma attacks and symptoms also reduced after systemic steroids despite persistence of steroid resistant IL-17+ cells and eosinophils.Paediatric STRA and DA have distinct airway molecular phenotypes with STRA characterised by elevated type2 cells. Systemic corticosteroids but not maintenance inhaled steroids resulted in improved symptom control and exacerbations concomitant with a reduction in functional ILC2s despite persistently elevated IL-17+ lymphoid cells.
Saglani S, 2019, Noninvasive Assessments of Airway Inflammation and Infection in Asthma and Wheezing Disorders, Publisher: WILEY, Pages: S36-S38, ISSN: 8755-6863
Saglani S, 2019, Difficult to Treat Asthma, Publisher: WILEY, Pages: S32-S34, ISSN: 8755-6863
Oksel C, Custovic A, Granell R, et al., 2019, Causes of variability in latent phenotypes of childhood wheeze, Journal of Allergy and Clinical Immunology, Vol: 143, Pages: 1783-1790.e11, ISSN: 0091-6749
BackgroundLatent class analysis (LCA) has been used extensively to identify (latent) phenotypes of childhood wheezing. However, the number and trajectory of discovered phenotypes differed substantially between studies.ObjectiveWe sought to investigate sources of variability affecting the classification of phenotypes, identify key time points for data collection to understand wheeze heterogeneity, and ascertain the association of childhood wheeze phenotypes with asthma and lung function in adulthood.MethodsWe used LCA to derive wheeze phenotypes among 3167 participants in the ALSPAC cohort who had complete information on current wheeze recorded at 14 time points from birth to age 16½ years. We examined the effects of sample size and data collection age and intervals on the results and identified time points. We examined the associations of derived phenotypes with asthma and lung function at age 23 to 24 years.ResultsA relatively large sample size (>2000) underestimated the number of phenotypes under some conditions (eg, number of time points <11). Increasing the number of data points resulted in an increase in the optimal number of phenotypes, but an identical number of randomly selected follow-up points led to different solutions. A variable selection algorithm identified 8 informative time points (months 18, 42, 57, 81, 91, 140, 157, and 166). The proportion of asthmatic patients at age 23 to 24 years differed between phenotypes, whereas lung function was lower among persistent wheezers.ConclusionsSample size, frequency, and timing of data collection have a major influence on the number and type of wheeze phenotypes identified by using LCA in longitudinal data.
Saglani S, Fleming L, Sonnappa S, et al., 2019, Advances in the aetiology, management, and prevention of acute asthma attacks in children, LANCET CHILD & ADOLESCENT HEALTH, Vol: 3, Pages: 354-364, ISSN: 2352-4642
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- Citations: 26
Saglani S, Menzie-Gow AN, 2019, Approaches to Asthma diagnosis in children and adults, Frontiers in Pediatrics, Vol: 7, Pages: 1-11, ISSN: 2296-2360
Although the hallmark features of asthma include reversible airflow obstruction, airway eosinophilia, and symptoms of recurrent wheeze associated with breathlessness and cough, it is a heterogeneous disease. The extent of the pathophysiological abnormalities are variable between patients. Despite this, until recently, asthma diagnosis had been made very simplistically predominantly from a clinical history and examination, and often a trial of medication such as short acting bronchodilators. The limitations of this approach have become increasingly apparent with evidence of inappropriate over diagnosis, under diagnosis and misdiagnosis. Although there is no gold standard single test to make a diagnosis of asthma, there are several objective tests that can be used to support the diagnosis including physiological measures such as obstructive spirometry associated with bronchodilator reversibility and airway hyperresponsiveness. In addition, non-invasive tests of airway inflammation such as exhaled nitric oxide or peripheral blood eosinophils are important to identify those with an allergic or eosinophilic phenotype. Diagnostic guidelines reflect the importance of using objective tests to support a diagnosis of asthma, however practical application in the clinic may not be straightforward. The focus of this review is to discuss the need to undertake objective tests in all patients to support asthma diagnosis and not just rely on clinical features. The advantages, challenges and limitations of performing tests of lung function and airway inflammation in the clinic, the difficulties related to training and interpretation of results will be explored, and the utility and relevance of diagnostic tests will be compared in adults and children.
Bloom C, Saglani S, Feary J, et al., 2019, Changing prevalence of current asthma and inhaled corticosteroid treatment in the UK: population based cohort 2006 to 2016, European Respiratory Journal, Vol: 53, Pages: 1-8, ISSN: 0903-1936
BACKGROUND:Asthma is the most common respiratory disorder in the UK, yet we have incomplete knowledge on the prevalence of current disease, treatment and exacerbations.METHODS:We used UK electronic healthcare records, 2006 to 2016, to estimate the prevalence of current asthma by year, gender and age (<5, 5-11, 12-17, 18-24, 25-54 and ≥55 years), and the proportion prescribed inhaled corticosteroids (ICS) and additional asthma-therapy, treated for exacerbations and other asthma care markers. RESULTS:Overall current asthma prevalence was 6.5% in 2016 (7.2% in 2006). Prevalence fell in those under 45 years. The lowest prevalence and largest absolute decrease was in children under 5-years. In 2016, 80% of current asthma patients were managed on ICS, (65% in 2006); this increase occurred in all ages, primarily due to an increase in low-dose ICS. During this time there was an increase in all age-groups in the proportion prescribed additional asthma-therapy, treated for an exacerbation within primary care, given an annual asthma review or management plan. Hospitalised exacerbations showed minimal change over time.CONCLUSION:Asthma remains highly prevalent and a significant healthcare burden. In those with a diagnosis, there was an increase in ICS prescriptions and treatment of exacerbations across all age-groups. This may reflect a trend towards more aggressive asthma management within primary care. An apparent decline in prevalence was observed in those aged under 45 years, particularly in children under 5 years.
Robinson PFM, Pattaroni C, Cook J, et al., 2019, Lower airway microbiota associates with inflammatory phenotype in severe preschool wheeze, Journal of Allergy and Clinical Immunology, Vol: 143, Pages: 1607-1610.e, ISSN: 0091-6749
Selby L, Saglani S, 2019, Severe asthma in children: therapeutic considerations, Current Opinion in Allergy and Clinical Immunology, Vol: 19, Pages: 132-140, ISSN: 1473-6322
Purpose of review Children with poor asthma control despite maximal maintenance therapy have problematic severe asthma(PSA). A step-wise approach including objective adherence monitoring and a detailed multidisciplinaryteam assessment to identify modifiable factors contributing to poor control is needed prior to consideringtherapy escalation. Pathophysiological phenotyping in those with true severe therapy-resistant asthma(STRA) and the current array of add-on therapies will be discussed.Recent findingsAdherence monitoring using electronic devices has shown that only 20–30% of children with PSA haveSTRA and need additional therapies. Omalizumab and mepolizumab are licensed for children with STRAaged 6 years and older. Although robust safety and efficacy data, with reduced exacerbations, areavailable for omalizumab, biomarkers predicting response to treatment are lacking. Paediatric safety dataare available for mepolizumab, but efficacy data are unknown for those aged 6–11 years and minimal forthose 12 years and older. A sub-group of children with STRA have neutrophilia, but the clinicalsignificance and contribution to disease severity remains uncertain.SummaryMost children with PSA have steroid sensitive disease which improves with adherence to maintenanceinhaled corticosteroids. Add-on therapies are only needed for the minority with STRA. Paediatric efficacydata of novel biologics and biomarkers that identify the optimal add-on for each child are lacking. If weare to progress toward individualized therapy for STRA, pragmatic clinical trials of biologics in accuratelyphenotyped children are needed.
Saglani S, Bush A, Carroll W, et al., 2019, Biologics for paediatric severe asthma: Trick or TREAT?, The Lancet Respiratory Medicine, Vol: 7, Pages: 294-296, ISSN: 2213-2600
Wang K, Elliot J, Saglani S, et al., 2019, THICKENING OF THE AIRWAY SMOOTH MUSCLE LAYER FROM LATE GESTATION TO CHILDHOOD IS FACILITATED BY INCREASED MEAN CELL VOLUME, Publisher: WILEY, Pages: 76-76, ISSN: 1323-7799
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- Citations: 1
Saglani S, Custovic A, 2019, Childhood asthma: Advances using machine learning and mechanistic studies, American Journal of Respiratory and Critical Care Medicine, Vol: 199, ISSN: 1073-449X
A paradigm shift brought by the recognition that childhood asthma is a heterogeneous condition comprising several endotypes underpinned by different pathophysiology, coupled with advances in understanding important causal mechanisms, offers a real opportunity for a step change to reduce the burden of the disease on individual children, families and society. Data-driven approaches have provided a framework for revealing hidden structure within large datasets. One way of bridging findings from data-driven analyses into clinical practice is to link "phenotypes" identified using such techniques with a specific pathology. Epidemiological studies have provided important clues about mechanistic avenues that should be pursued to identify interventions to prevent asthma development or alter its natural history. Findings from cohort studies followed by mechanistic studies in humans and in neonatal mouse models have suggested that environments such as traditional farming may provide protection by modulating innate immune responses, and that impaired innate immunity may increase asthma susceptibility. The key question of which component of these exposures can be translated into interventions requires confirmation. Increasing mechanistic evidence is demonstrating that shaping the airway microbiome in early life may modulate immune function to confer protection. If we are to make advances, we have to foster cross-disciplinary collaborations between data scientists who turn "big data" into useful information about the hidden structures within large dataset which may help disaggregate "asthma", with medical professionals and basic scientists who provide critical clinical and mechanistic insights about the mechanisms underpinning the architecture of the heterogeneity, to deliver mechanism-based stratified treatments and prevention.
Saglani S, Fleming L, Sonnappa S, et al., 2019, Recent advances in the aetiology, management and prevention of acute asthma attacks, Lancet Child and Adolescent Health, ISSN: 2352-4642
Acute attacks of wheeze or asthma remain among the most common reasons for paediatric hospital attendance and rates of severe attacks in the UK are among the highest in Europe. Although most attacks are precipitated by infection, there are critical differences in the underlying pathophysiology between preschool and school-aged children. Allergen sensitisation, airway eosinophilia and type 2 inflammation are predominant in older children, while phenotypes in younger children are variable, often including non-atopic, neutrophilic infection driven episodes. Currently, a universal approach is adopted towards management in all ages, but there is a need to make objective assessments of airway function, inflammation and infection both during the attack and in disease stability to identify “treatable traits” and target therapy if we are to improve outcomes. An assessment of risk factors that led to the attack and early, focussed follow-up is essential to ensure attacks are a “never event”.
Saglani S, Lloyd CM, 2019, 43 - The Immunopathogenesis of Asthma, Kendig's Disorders of the Respiratory Tract in Children, Pages: 665-676.e3, ISBN: 9780323448871
Asthma occurs as a result of the interplay of genetic susceptibility and environmental influences on the developing lungs and immune system. Asthma in children is predominantly associated with the development of allergic sensitization and the pathological features of eosinophilic airway inflammation and structural airway wall changes, collectively termed airway remodeling. The clinical manifestation of disease is heterogeneous but includes symptoms of breathlessness and wheeze, which result from bronchoconstriction. Acute attacks in children commonly result from respiratory infection, with repeated episodes of infection with rhinovirus and respiratory syncytial virus in early life being especially associated with the risk of recurrent wheezing and asthma in children who also develop early allergic sensitization and have a genetic susceptibility. The focus of this chapter is to discuss the basic immunological mechanisms that drive the pathophysiology of asthma, with specific focus on the close interactions between innate and adaptive immune responses in driving disease. The immunopathology of specific clinical manifestations of disease, including exacerbations and preschool wheezing disorders, will also be discussed, and mechanisms that are unique to the developing pediatric airway and that cannot be extrapolated from adult disease will be highlighted.
Saglani S, Lloyd CM, Bush A, 2019, Biology and Assessment of Airway Inflammation, Kendig's Disorders of the Respiratory Tract in Children, Pages: 101-119.e4, ISBN: 9780323448871
The nature and development airway inflammation may be driven by numerous factors, including pathogenic infections, pollution, or even relatively innocuous inhaled particles, such as allergens. A robust inflammatory response is essential to fight pathogens, but both active inflammation and efficient resolution are equally important. The failure of resolution or persistent proinflammatory immune responses results in chronic inflammatory airway diseases. These may be characterized by persistent neutrophilic inflammation, as is the case in cystic fibrosis and chronic suppurative lung diseases, or persistent eosinophilia, as is seen in allergic asthma. It is essential to accurately undertake an assessment of the airway inflammatory phenotype in chronic airways diseases to allow an understanding of the mechanisms mediating disease and identify appropriate therapeutic targets. It is also becoming increasingly important to phenotype airway inflammation in individual patients to allow targeted treatment as we move towards personalized therapies. This chapter will discuss what is known about the mechanisms driving chronic inflammatory airways diseases in children and provide an update on the methods used to investigate airway inflammation invasively and noninvasively in patients to allow phenotype driven and targeted therapies.
Robinson PF, Pattaroni C, Cook J, et al., 2019, Lower Airway Microbiota Associates with Inflammatory Phenotype in Severe Preschool Wheeze, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
King JA, Saglani S, Bush A, et al., 2018, CLINICAL CHARACTERISTICS OF PRE-SCHOOL CHILDREN WITH MANNOSE BINDING LECTIN DEFICIENCY UNDERGOING BRONCHOSCOPY, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A152-A153, ISSN: 0040-6376
Ananth S, Cook J, Gregory L, et al., 2018, LOWER AIRWAY PATHOLOGICAL PHENOTYPES DO NOT RELATE TO CLINICAL PHENOTYPES IN PRESCHOOL CHILDREN WITH SEVERE, RECURRENT WHEEZE, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A4-A4, ISSN: 0040-6376
Bloom CI, Feary J, Jarvis D, et al., 2018, CHANGING PREVALENCE OF CURRENT ASTHMA AND INHALED CORTICOSTEROID TREATMENT IN THE UK: POPULATION BASED COHORT 2006 TO 2016, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A63-A64, ISSN: 0040-6376
Selby LA, Saglani S, Fleming L, et al., 2018, ASSESSMENT OF ADRENAL FUNCTION USING LOW DOSE AND STANDARD DOSE SYNACTHEN TESTS IN A COHORT OF PAEDIATRIC ASTHMA PATIENTS, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A150-A151, ISSN: 0040-6376
Roberts G, Almqvist C, Boyle R, et al., 2018, Developments in the field of allergy in 2017 through the eyes of Clinical and Experimental Allergy, CLINICAL AND EXPERIMENTAL ALLERGY, Vol: 48, Pages: 1606-1621, ISSN: 0954-7894
Bush A, Saglani S, 2018, Structurally unsound? Why airways become asthmatic, American Journal of Respiratory Cell and Molecular Biology, Vol: 59, Pages: 405-406, ISSN: 1044-1549
Benn CS, Hornef M, Naik S, et al., 2018, Immunity in the Very Young: Challenges and Opportunities, IMMUNITY, Vol: 49, Pages: 377-378, ISSN: 1074-7613
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