Reviews and feature articleUsing biomarkers in the assessment of airways disease
Section snippets
Using a biomarker: What are the clinical objectives?
The measurement of a biomarker can have several objectives. It is important to understand those that can and, just as importantly, those that cannot be served by making the measurement. There are several domains (Table II), and the proven utility of a biomarker in one domain may not be the case for another.
Diagnosis
The success with which a biomarker operates in diagnostic decision making depends on its performance characteristics. The terminology is familiar: sensitivity, specificity, PPV and negative predictive value (NPV), and likelihood ratios (LRs, both positive and negative). Unfortunately, familiarity with the terms does not guarantee that we understand them, and this often leads to inappropriate expectations and mistaken applications of a diagnostic test.
A sensitive test identifies most subjects
Anti-inflammatory therapy in patients with airways disease
The most clinically important role for a biomarker in airways disease management is to predict the response to anti-inflammatory treatment. Current guidelines for asthma recommend a universal step-up regimen rather than a selective approach,52 but in fact, the response to ICS therapy is heterogeneous, and nonresponders are common.53, 54 In the Gaining Optimal Asthma Control study approximately 30% of patients did not achieve asthma control despite progressive increases in their inhaled
Summary
The use of biomarkers in respiratory medicine is in its infancy. Successive studies proclaim the relevance of yet another biomarker for the clinical evaluation of airways disease, but the pathway from identification to clinical application is long and complex. Yet there is an urgent need to develop biomarkers that enable clinicians to distinguish one clinical phenotype from another. Even more importantly, biomarkers should be aimed at identifying treatment responders. Targeted therapy is the
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Series editors: Joshua A. Boyce, MD, Fred Finkelman, MD, William T. Shearer, MD, PhD, and Donata Vercelli, MD
Disclosure of potential conflict of interest: D. R. Taylor has received lecture fees from Aerocrine AB.
Terms in boldface and italics are defined in the glossary on page 928.