References of "Schleich, FLorence"
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See detailAsthma Control and Sputum Eosinophils: a Longitudinal Study in Daily Practice
Demarche, Sophie ULg; SCHLEICH, FLorence ULg; HENKET, Monique ULg et al

Scientific conference (2015, June 12)

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See detailClinically relevant subgroups in COPD and asthma.
Turner, Alice M.; Tamasi, Lilla; SCHLEICH, FLorence ULg et al

in European respiratory review : an official journal of the European Respiratory Society (2015), 24(136), 283-98

As knowledge of airways disease has grown, it has become apparent that neither chronic obstructive pulmonary disease (COPD) nor asthma is a simple, easily defined disease. In the past, treatment options ... [more ▼]

As knowledge of airways disease has grown, it has become apparent that neither chronic obstructive pulmonary disease (COPD) nor asthma is a simple, easily defined disease. In the past, treatment options for both diseases were limited; thus, there was less need to define subgroups. As treatment options have grown, so has our need to predict who will respond to new drugs. To date, identifying subgroups has been largely reported by detailed clinical characterisation or differences in pathobiology. These subgroups are commonly called "phenotypes"; however, the problem of defining what constitutes a phenotype, whether this should include comorbid diseases and how to handle changes over time has led to the term being used loosely. In this review, we describe subgroups of COPD and asthma patients whose clinical characteristics we believe have therapeutic or major prognostic implications specific to the lung, and whether these subgroups are constant over time. Finally, we will discuss whether the subgroups we describe are common to both asthma and COPD, and give some examples of how treatment might be tailored in patients where the subgroup is clear, but the label of asthma or COPD is not. [less ▲]

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See detailTraitement personnalisé dans l'asthme : le cas des anticorps monoclonaux dirigés contre l'interleukine-5.
LOUIS, Renaud ULg; Demarche, Sophie ULg; Van Hees, Thierry ULg et al

in Revue Médicale de Liège (2015), 70(5-6), 306-9

Asthma is a chronic inflammatory disease that often features eosinophilia, especially in its most severe forms. Monoclonal antibodies directed towards interleukin-5, such as mepolizumab or reslizumab ... [more ▼]

Asthma is a chronic inflammatory disease that often features eosinophilia, especially in its most severe forms. Monoclonal antibodies directed towards interleukin-5, such as mepolizumab or reslizumab, were shown to be very effective at reducing blood and airways eosinophilia. When administered monthly by intravenous or subcutaneous injection in severe eosinophilic asthmatic patients, they reduce severe exacerbation rate by 50 %, improve asthma control and quality of life, and have an oral glucocorticoids sparing effect in those requiring oral corticoids as maintenance therapy. [less ▲]

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See detailEtude du phénotype mixte BPCO-asthme dans une série de patients BPCO en état stable
Nguyen, M.-S.; NGUYEN DANG, Delphine ULg; SCHLEICH, FLorence ULg et al

in Revue Médicale de Liège (2015), 70(1), 37-43

Résumé : Le but de ce travail était d’évaluer la prévalence et de décrire les caractéristiques du phénotype mixte BPCO-asthme parmi les patients BPCO stables de stade II à IV selon la classification de ... [more ▼]

Résumé : Le but de ce travail était d’évaluer la prévalence et de décrire les caractéristiques du phénotype mixte BPCO-asthme parmi les patients BPCO stables de stade II à IV selon la classification de GOLD. Matériel et méthodes : entre mai 2013 et avril 2014, 46 patients consécutifs furent recrutés à partir des consultations de Pneumologie du CHU de Liège. Ils étaient considérés comme présentant un syndrome mixte BPCO-asthme si leur indice de Tiffeneau était < 70% après bronchodilatation et s’accompagnait soit d’un antécédent d’asthme avant l’âge de 40 ans, soit d’au moins deux des trois critères suivants: 1) réversibilité bronchique significative (changement du VEMS après la bronchodilatation ≥ 200 ml et ≥ 12%), 2) inflammation éosinophilique: éosinophiles dans les expecto-rations ≥ 3% ou/et éosinophiles dans le sang ≥ 400/μl ou/et FENO ≥ 45 ppb, 3) histoire d’allergie respiratoire, ou IgE sériques totales ≥ 113 KU/l, ou RAST ≥ 0,35 KU/l à l’égard d’un des principaux aéroallergènes. Le phénotype mixte BPCO-asthme fut observé chez 37% des patients. L’expression symptomatique était plus marquée dans le groupe de phénotype mixte que dans le groupe de BPCO pure (CAT 24,6 ± 8,1 vs 19,4 ± 8, p < 0,05) en dépit d’un déficit spiro-métrique identique. Le coefficient de transfert alvéolo-capillaire (DLCO/VA%) était préservé dans le phénotype mixte (97 ± 24%) et supérieur à celui mesuré chez les patients BPCO pure (80 ± 20%) (p < 0,05). La prévalence du phéno-type mixte est voisine d’un tiers chez les patients BPCO et ces sujets ont une expression symptomatique plus marquée, sans signe d’obstruction bronchique plus sévère. [less ▲]

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See detailLes corticoïdes inhalés sont-ils suffisants pour traiter l'asthme? Perspective historique
LOUIS, Renaud ULg; Demarche, Sophie ULg; SCHLEICH, FLorence ULg

in Vaisseaux, Coeur, Poumons (2015), 20(4), 66-68

Cet article retrace l'évolution du traitement médicamenteux de l'asthme depuis l'avènement des corticoïdes inhalés à la fin des années 80. Une meilleure compréhension de la maladie, de ses différents ... [more ▼]

Cet article retrace l'évolution du traitement médicamenteux de l'asthme depuis l'avènement des corticoïdes inhalés à la fin des années 80. Une meilleure compréhension de la maladie, de ses différents phénotypes et des cytokins et médiateurs protéiques impliqués dans les différentes voies inflammatoires, a ouvert la porte à une prise en charge plus pointue de la maladie et plus particulièrement de ses formes sévères. A l'heure actuelle, le traitement des patients atteints d'asthme sévère requiert une caractérisation plus poussée de la maladie. [less ▲]

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See detailDiagnosis and clinical interest of asthma inflammatory phenotypes
SCHLEICH, FLorence ULg

Doctoral thesis (2014)

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See detailHeterogeneity of phenotypes in severe asthmatics. The Belgian Severe Asthma Registry (BSAR).
SCHLEICH, FLorence ULg; Brusselle, G.; Louis, Renaud ULg et al

in Respiratory medicine (2014), 108(12), 1723-32

The Belgian severe asthma registry is a web-based registry encompassing demographic, clinical, functional and inflammatory data of severe asthmatics (SA), aiming at improving awareness, knowledge on its ... [more ▼]

The Belgian severe asthma registry is a web-based registry encompassing demographic, clinical, functional and inflammatory data of severe asthmatics (SA), aiming at improving awareness, knowledge on its natural history and subphenotypes, and offering tools to optimize care of this asthma population. METHODS: The cross-sectional analyses of this registry included 350 SA as defined by the ATS (2000) from 9 Belgian centres, with at least one year follow up. RESULTS: Mean age was 55 +/- 14 yrs. SA were more frequently female (57%) and atopic (70%). Late-onset asthma (>/=40 yr) was observed in 31% of SA. Current smokers represented 12% while 31% were ex-smokers. In addition to high doses ICS + LABA, 65% of patients were receiving LTRA, 27% anti-IgE and 24% maintenance oral corticosteroids (8 mg (Interquartile range-IQR:4-8) methylprednisolone). Despite impaired airflow (median FEV1:67%; IQR: 52-81) only 65% had a post-bronchodilator FEV1/FVC ratio <70%. The median blood eosinophil count was 240/mm(3). The median FENO was 26 ppb (IQR: 15-43) and 22% of SA had FENO >/= 50 ppb. Induced sputum was successful in 86 patients. Eosinophilic asthma (sputum Eos >/= 3%) was the predominant phenotype (55%) while neutrophilic (sputum Neu >/= 76%) and paucigranulocytic asthma accounted for 22% and 17% respectively. Comorbidities included rhinitis and chronic rhinosinusitis (49%), nasal polyposis (19%), oesophageal reflux (36%), overweight and obesity (47%) and depression (19%). In addition, 8% had aspirin-induced asthma and 3% ABPA. Asthma was not well-controlled in 83% according to ACT < 20 and 77% with ACQ > 1.5. CONCLUSION: In this cohort of patients with severe asthma, the majority displayed indices of persistent airflow limitation and eosinophilic inflammation despite high-dose corticosteroids, suggesting potential for eosinophil-targeted biotherapies. [less ▲]

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See detailThermoplastie bronchique : une réelle avancée dans le traitement de l'asthme
HEINEN, Vincent ULg; SCHLEICH, FLorence ULg; DUYSINX, Bernard ULg et al

in Revue Médicale Suisse (2014), 10(439), 1544-1548

New treatments are needed to improve the care of severe asthmatic patients. Bronchial thermoplasty aims to lessen the airway smooth muscles via the heating of bronchial walls by radiofrequency. The ... [more ▼]

New treatments are needed to improve the care of severe asthmatic patients. Bronchial thermoplasty aims to lessen the airway smooth muscles via the heating of bronchial walls by radiofrequency. The preliminary studies showed a good tolerance and some good efficacy. Randomized controlled trials have been undertaken on moderate to severe asthmatic patients, demonstrating an improvement in quality of life, rate of severe exacerbations and unscheduled medical visits. The main side-effects consist of asthma exacerbations, atelectasis and infections. Bronchial thermoplasty is an innovative treatment with good efficacy and acceptable tolerance for moderate to severe asthmatic patients. More studies are needed to better understand its mechanism of action and more clearly delineate the precise indications of this innovative technique. [less ▲]

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See detailPhenotypes de la broncho-pneumopathie chronique obstructive.
Corhay, Jean-Louis ULg; SCHLEICH, FLorence ULg; Louis, Renaud ULg

in Revue medicale de Liege (2014), 69(7-8), 415-21

Chronic Obstructive Pulmonary Disease (COPD) is a multi-dimensional disorder with multiple phenotypes. The GOLD guidelines, used for the diagnosis, staging and treatment of COPD, do not fully reflect the ... [more ▼]

Chronic Obstructive Pulmonary Disease (COPD) is a multi-dimensional disorder with multiple phenotypes. The GOLD guidelines, used for the diagnosis, staging and treatment of COPD, do not fully reflect the heterogeneous nature of the disease. Historically, the two most recognized clinical phenotypes of COPD are emphysema and chronic bronchitis. Most COPD patients encountered in practice actually share, both of these features. Genetic background, clinical presentation, variation in the response to treatment and propensity to exacerbations may also identify other phenotypes. Recently, using a mathematical approach, such as cluster analysis, which is based on pre-selected parameters, other interesting phenotypes were identified. A precise definition of COPD phenotypes should lead to a more targeted therapeutic approach based on these phenotypes. The purpose of this article is to point out that COPD is a heterogeneous disease and to summarize the current data available about the phenotypes of this disease. [less ▲]

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See detailImportance of concomitant local and systemic eosinophilia in uncontrolled asthma - Letter from the authors to editor
SCHLEICH, FLorence ULg; LOUIS, Renaud ULg

in The European respiratory journal (2014), 44(4), 1098-9

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See detailAsthme bronchique non contrôlé : importance des phénotypes et de l'inflammation eosinophilique locale et systémique.
SCHLEICH, FLorence ULg; LOUIS, Renaud ULg

in Revue Médicale de Liège (2014), 69 Spec No

Asthma is a complex chronic inflammatory disease of the airways. Eosinophilia is a recognized feature of asthma. Asthma is no more considered as a single disease, but there are several subtypes of ... [more ▼]

Asthma is a complex chronic inflammatory disease of the airways. Eosinophilia is a recognized feature of asthma. Asthma is no more considered as a single disease, but there are several subtypes of bronchial asthma, also called phenotypes, that have therapeutic and prognostic implications. Asthmatics are now classified according to inflammatory phenotypes that allow a personalized therapy. Phenotype identification requires induced sputum analysis that is not widely available. In this context, we have identified surrogate markers for inflammatory phenotypes. An eosinophilic phenotype can lbe suspected in case of concomitant increase of exhaled nitric oxide, blood eosinophils, IgE levels and airway obstruction. We have also identified a subgroup of asthmatics exhibiting diffuse local and systemic eosinophilia. This subgroup has a more severe asthma,a lower asthma control and a higher number of exacerbations. [less ▲]

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See detailImportance of concomitant local and systemic eosinophilia in uncontrolled asthma.
SCHLEICH, FLorence ULg; Chevremont, Anne; Paulus, Virginie et al

in The European respiratory journal (2014), 44

Systemic and airway eosinophilia are recognised features of asthma. There are, however, patients who exhibit discordance between local and systemic eosinophilia. In this study, we sought to determine the ... [more ▼]

Systemic and airway eosinophilia are recognised features of asthma. There are, however, patients who exhibit discordance between local and systemic eosinophilia. In this study, we sought to determine the prevalence and characteristics of patients with concordant and discordant systemic and bronchial eosinophilia.We conducted a retrospective study on 508 asthmatics with successful sputum induction. We assessed the relationship between blood and sputum eosinophils by breaking down the population into four groups according to blood (>/=400 cells per mm3) and sputum (>/=3%) eosinophils. Then, we prospectively reassessed the link between eosinophils and asthma control (Asthma Control Questionnaire (ACQ)) and exacerbation rate in a new cohort of 250 matched asthmatics.In our retrospective cohort, asthmatics without eosinophilic inflammation were the largest group (49%). The group with isolated sputum eosinophilia (25%) was, compared with noneosinophilic asthma, associated with lower forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity ratio and higher bronchial hyperresponsiveness and exhaled nitric oxide fraction (FeNO). Asthmatics exhibiting isolated systemic eosinophilia (7%) had similar characteristics as noneosinophilic asthmatics. The group with concordant systemic and airway eosinophilia (19%) showed remarkable male predominance, and had the lowest airway calibre, ACQ score and quality of life, and the highest bronchial hyperresponsiveness, FeNO and exacerbation rate. The prospective cohort confirmed the different subgroup proportions and the higher ACQ and exacerbation rates in cases of diffuse eosinophilia compared with noneosinophilic asthmatics.Concomitant systemic and bronchial eosinophilic inflammation contribute to poor asthma control. [less ▲]

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See detailDistribution of sputum cellular phenotype in a large asthma cohort: predicting factors for eosinophilic vs neutrophilic inflammation.
SCHLEICH, FLorence ULg; Manise, Maïté ULg; Sele, Jocelyne et al

in BMC Pulmonary Medicine (2013), 13(1), 11

ABSTRACT: BACKGROUND: Phenotyping asthma according to airway inflammation allows identification of responders to targeted therapy. Induced sputum is technically demanding. We aimed to identify predictors ... [more ▼]

ABSTRACT: BACKGROUND: Phenotyping asthma according to airway inflammation allows identification of responders to targeted therapy. Induced sputum is technically demanding. We aimed to identify predictors of sputum inflammatory phenotypes according to easily available clinical characteristics. METHODS: This retrospective study was conducted in 508 asthmatics with successful sputum induction recruited from the University Asthma Clinic of Liege. Receiver-operating characteristic (ROC) curve and multiple logistic regression analysis were used to assess the relationship between sputum eosinophil or neutrophil count and a set of covariates. Equations predicting sputum eosinophils and neutrophils were then validated in an independent group of asthmatics. RESULTS: Eosinophilic (>=3%) and neutrophilic (>=76%) airway inflammation were observed in 46% and 18% of patients respectively. Predictors of sputum eosinophilia >=3% were high blood eosinophils, FENO and IgE level and low FEV1/FVC. The derived equation was validated with a Cohen's kappa coefficient of 0.59 (p < 0.0001). ROC curves showed a cut-off value of 220/mm3 (AUC = 0.79, p < 0.0001) or 3% (AUC = 0.81, p < 0.0001) for blood eosinophils to identify sputum eosinophilia >=3%. Independent predictors of sputum neutrophilia were advanced age and high FRC but not blood neutrophil count. CONCLUSION: Eosinophilic and paucigranulocytic asthma are the dominant inflammatory phenotypes. Blood eosinophils provide a practical alternative to predict sputum eosinophilia but sputum neutrophil count is poorly related to blood neutrophils. [less ▲]

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