Page 85 - ADULT-ONSET ASTHMA PREDICTORS OF CLINICAL COURSE AND SEVERITY

DIAGNOSTIC ACCURACY OF MINIMALLY INVASIVE MARKERS FOR DETECTION OF AIRWAY EOSINOPHILIA IN ASTHMA
surrogate tests for detec ng airway eosinophilia in asthma. Our meta-analyses show that, at the op mal cutpoint, sensi vi es and speci ci es of these markers for detec ng sputum eosinophilia are moderate, and their use would lead to large numbers of false posi ves and/ or false nega ves. Future research will mainly need to focus on whether these markers can be applied as rule-in or rule-out tests, whether markers that were poorly inves gated or clinical predic on models incorpora ng mul ple markers along with other clinical data are more accurate, perhaps in speci c se ngs or subgroups, and whether these markers on their own merits have poten al in managing asthma26. A next step could be an extensive IPD project, combining exis ng datasets from observa onal asthma studies in which both clinical features, minimally invasive markers, and one or more reference standards for airway eosinophilia were assessed. Thresholds for ruling-in and ruling-out airway eosinophilia based on individual markers can then be reliably determined, and an op mal mul variable clinical predic on model can be developed. The clinical value of these ndings can subsequently be inves gated in terms of, for example, response to therapy or the reduc on of exacerba ons.
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