Advanced Diagnostic Testing, Innovative Treatments for Adults with Asthma

By Sumita Khatri, MD and David Lang, MD

At Cleveland Clinic Asthma Center, experts in Pulmonary Medicine and Allergy and Immunology offer advanced diagnostic testing and innovative treatments for adults with asthma. For those with coexisting conditions, we also coordinate care with otolaryngology and speech therapy, gastroenterology, endocrinology and cardiology.

In addition to general asthma care, we offer our patients the following specialized programs:

• Care for Patients with Severe Asthma includes patients who chronically require multiple medications or oral steroids to remain controlled; have high risk asthma that has resulted in lost days of school or work, or hospitalizations; or are disabled from symptoms or adverse effects of medications. Our protocol explores personalized asthma endotypes in which pathobiology of disease is considered when a management plan is initiated. Therapies offered include biologic treatments (e.g. mepolizumab, omalizumab), aspirin desensitization and bronchial thermoplasty.
• Asthma care and public health advocacy for patients in our community: Our efforts include (1) advocacy around air quality, access to care and medications; (2) coordinating and reducing barriers to care for patients presenting to the Emergency Department, who are at highest risk from their asthma; (3) using technologies such as electronic registries and telemedicine to aid access; and (4) monitoring quality metrics regarding the identification of at-risk patients and management of asthma.
• Chronic Cough Clinic: This collaborative effort involving staff from pulmonary medicine, otorhinolaryngology and gastroenterology provides a multidisciplinary approach to the evaluation and treatment of chronic cough.
• Exercise-induced dyspnea in high-performing athletes: Our program provides evaluation for, and treatment of, various causes for exercise limitation among elite athletes including occult upper airway abnormalities and pulmonary vascular, cardiac or gastrointestinal conditions. Assessment and care is coordinated among a multidisciplinary team representing pulmonary medicine, cardiology, otolaryngology, gastroenterology and speech therapy.

We are also involved in a wide array of basic, translational and clinical research projects:

• Programmatic research funded by the National Heart Lung Blood Institute (NHLBI) aims to uncover the primary causes of asthma and the pathobiology of severe asthma. Special areas of study include gender effects on asthma severity, obesity and diet in airway inflammation, epithelial and T-cell mediators in asthma origins, and the role of extracellular pathologic remodeling of the airway mucosa.
• NHLBI-funded translational programs are developing novel diagnostics and predictive testing for asthma phenotypes, with the goal of identifying molecular signatures of types of asthma so that precision therapies can be applied, in particular for the severe unremitting asthma phenotype.
• Longitudinal studies of asthma in the NHLBI-Severe Asthma Research Program (SARP) provide information about the natural history of severe asthma and how biomarkers may identify asthma exacerbations over time.
• Epidemiologic studies of asthma populations at Cleveland Clinic and in national databases investigate the intrinsic and environmental factors in asthma control and exacerbations.

Dr. Khatri is staff in Pulmonary Medicine and Pathobiology and is Co-Director of the Asthma Center. Dr. Lang is Chair of the Department of Allergy and Clinical Immunology and Co-Director of the Asthma Center.