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Study Objectives: Eosinophils and neutrophils play major roles, respectively, in the pathogenesis of asthma and COPD, and it is well recognized that levels of these cells in peripheral blood are increased in relation to their pulmonary involvement. However, the relation between peripheral blood cell counts of the other major leukocyte groups and these lung diseases or markers of allergy or airflow obstruction is less clear. We have therefore investigated the association between peripheral blood levels of eosinophils, neutrophils, basophils, monocytes, and lymphocytes and the occurrence of chronic respiratory symptoms, atopy, lung function, and bronchial hyperresponsiveness, and the modifying effect of age, in adults.Design: A cross-sectional general population study.Setting: Data on > 2,000 British adults, who originally participated in a study of diet and lung health, were analyzed using multiple linear and logistic regression to adjust for potential confounders, including age, sex, and smoking history.Results: We found that, like eosinophils, the peripheral basophil count was increased in relation to asthma and associated symptoms, and to airway hyperreactivity and increased total IgE, but differed from eosinophils in that basophils were unrelated to atopy. Monocytes were predominantly associated with symptoms indicative of obstructive airway disease, in similar relation to neutrophils, but both of these leukocyte counts were also increased in asthma patients in older age groups. Lymphocyte counts were unrelated to any objective or subjective marker of disease.Conclusions: If peripheral blood cell counts reflect pulmonary involvement of these leukocyte groups, basophils and monocytes may play a distinct role in the pathogenesis of allergic and nonallergic respiratory disease. [ABSTRACT FROM AUTHOR]

Asthma is a common multifaceted respiratory disease with a major impact on quality of life. Despite increased insights into mechanisms underlying various asthma phenotypes and endotypes and the availability of targeted biologic treatment options, the disease remains uncontrolled in a substantial proportion of patients with risk of exacerbations, requiring systemic corticosteroids, and with progressive disease. Current international guidelines advocate a personalized management approach to patients with uncontrolled severe asthma. The European Forum for Research and Education in Allergy and Airway Diseases asthma expert panel was convened to discuss strategies to optimize asthma care and to prevent systemic corticosteroid overuse and disease progression. In this meeting report, we summarize current concepts and recommendations and provide a rationale to implement personalized asthma management at earlier stages of the disease. The ultimate goal is to move away from the current one-size-fits-most concept, which focuses on a symptom-driven treatment strategy, and shift toward a phenotype- and endotype-targeted approach aimed at curbing the disease course by improving clinical outcomes and preserving health-related quality of life. Herein, we provide a consensus view on asthma care that advocates a holistic approach and highlight some unmet needs to be addressed in future clinical trials and population studies., Competing Interests: Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: M. J. has received consulting fees from ALK-Abello, Stallergenes-Greer, Takeda, and Zentiva; honoraria for lectures and presentations from ALK-Abello, Stallergenes-Greer, Takeda, Zentiva, AstraZeneca, Chiesi, CSL Behring, Novartis, and Pfizer; support for attending meetings, travel, or both from ALK-Abello, Stallergenes-Greer, Takeda, and Novartis; and honoraria for participation on advisory boards from ALK-Abello, Stallergenes-Greer, Chiesi, Novartis, Pfizer, and Sanofi Genzyme/Pasteur. A. B. received speaker’s honoraria or travel grants from Takeda, Novartis, Viatris, ALK, Zentiva, MERCK, Stallergenes Greer, Ewopharma, Astra Zeneca, Chiesi, S&D Pharma, Mundipharma, and Berlin Chemie. R. D. has been on advisory boards for ALK-Abello, GSK, and Sanofi-Genzyme-Regeneron and received honoraria for speaking at academic meetings sponsored by GlaxoSmithKline. He is a cofounder and consultant for Synairgen plc, where he owns shares. N. A. H. received honoraria from Sanofi, GSK, Amgen. Teva, Astra Zeneca, Genentech, and Verona Pharma and his institution received research grants from GSK, Genentech, Sanofi, and Astra Zeneca. L. G. H. has received grant funding, participated in advisory boards, and given lectures at meetings supported by Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Hoffmann La Roche, GlaxoSmithKline, Novartis, Theravance, Evelo Biosciences, Sanofi, and Teva; he has received grants from MedImmune, Novartis UK, Roche/Genentech, Inc., Glaxo Smith Kline, Amgen, Genentech/Hoffman La Roche, Astra Zeneca, MedImmune, Glaxo Smith Kline, Aerocrine, and Vitalograph; has received sponsorship for attending international scientific meetings from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, and Napp Pharmaceuticals; has taken part in asthma clinical trials sponsored by AstraZeneca, Boehringer Ingelheim, Hoffmann La Roche, and GlaxoSmithKline, for which his institution received remuneration; and is the academic lead for the Medical Research Council Stratified Medicine UK Consortium in Severe Asthma, which involves industrial partnerships with a number of pharmaceutical companies including Amgen, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Hoffmann la Roche, and Janssen. I. P. has received speaker’s honoraria for speaking at sponsored meetings in the last 5 years from Astra Zeneca, Boehringer Ingelheim, Aerocrine, Almirall, Novartis, Teva, Chiesi, Sanofi/Regeneron, Menarini, and GSK and payments for organizing educational events from AZ, GSK, Sanofi/Regeneron, and Teva; has received honoraria for attending advisory panels from Genentech, Sanofi/Regeneron, Astra Zeneca, Boehringer Ingelheim, GSK, Novartis, Teva, Merck, Circassia, Chiesi, and Knopp; has received payments to support Food and Drug Administration approval meetings from GSK; has received sponsorship to attend international scientific meetings from Boehringer Ingelheim, GSK, AstraZeneca, Teva, and Chiesi; and has received a grant from Chiesi to support a phase 2 clinical trial in Oxford. S. Q. has been on advisory boards for and has received speaker’s honoraria from ALK, Allergy Therapeutics, AstraZeneca, GlaxoSmithKline, Novartis, Chiesi, Mundipharma, and Sanofi-Regeneron in the last 3 years. D. R. has spoken on behalf of, provided consultancy to, or been sponsored to attend meetings by Viatris, Menarini, Sanofi, Thermo-Fisher, Chiesi, and Alk-Abello in the last 3 years. W. F. has received consultation or speaker fees, or both, from Dianosic, GSK, Novartis, and Sanofi-Aventis/Regeneron and the Department of Otorhinolaryngology of the Amsterdam University Medical Centre, location AMC, received grants for research in rhinology from ALK, AllergyTherapeutics, Novartis, EU, GSK, MYLAN, Sanofi-Aventis, and Zon-MW. D. C. serves as academic manager at the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) and as review editor at Frontiers in Allergy, rhinology section. P. W. H. has received research grants, honoraria, lecture fees, or a combination thereof from Sanofi, Regeneron, Viatris, GSK, and Novartis. G. S. has received honoraria for articles, speaker, and advisory boards from ALK, AstraZeneca, Capnia, Chiesi, Church & Dwight, Circassia, Noucor, GSK, Meda/Mylan/Viatris, Merck, Sanofi- Regeneron, and Stallergenes; is the scientific chief editor of the rhinology section of Frontiers in Allergy; is a board member and lead for allergic rhinitis of EUFOREA; and is chair of the data monitoring board for pediatric AR trials of HDM SLIT. L. H. B. has received speakers fees or attended advisory board meetings for the following companies: AstraZeneca, Acucort, Birk pharma, GlaxoSmithklein, and Sanofi Genzyme in the past 3 years. Z. D. received speaker or consultant honoraria, served on advisory boards, or both at ALK, Antabio, Arcede, Biosion, Foresee Pharmaceuticals, GalenusHealth, GlaxoSmithKline, Hippo-Dx, Pleuran, QPS-Netherlands, Sanofi-Genzyme-Regeneron, all outside the submitted work; during the last 3 years of her assignment as research director for respiratory and allergy, QPS-Netherlands received a European grant from ERA4TB and funding from Foresee Pharmaceuticals for early clinical studies; she also has been associate editor for allergy and respiratory medicine and chair of the asthma expert panel at EUFOREA (2020-2023). None declared (M. G., E. V. S.)., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)