Predicting Outcomes of High-Flow Nasal Cannula for Acute Respiratory Distress Syndrome. An Index that ROX

maintenance oral corticosteroid therapy, and alternative therapeutic approaches might be best, although these are limited for those with no evidence of eosinophilic inflammation.How can this precision medicine approach be further improved, particularly for those with no evidence of eosinophilic inflammation, to find new treatments?Differential analysis of the omics data characterizing each of these four clusters may provide clues to the pathways that may underlie corticosteroid responsiveness.The other approach would be to first cluster on available transcriptomic or proteomic data.Taking this approach in the U-BIOPRED (Unbiased BIOmarkers in PREDiction of respiratory disease outcomes project) cohort, Kuo and colleagues clustered transcriptomic pathways associated with inflammatory and immune mechanisms in bronchial biopsies and epithelial cells using machine learning to obtain T2-high molecular phenotypes associated with corticosteroid insensitivity (11).With use of an inference scheme, these molecular clusters could be predicted by using the inflammatory biomarkers of sputum eosinophilia and FE NO levels, together with oral corticosteroid use, with good sensitivity and specificity.The work of Wu and colleagues emphasizes the need for the unsupervised approach and the application of machine learning techniques that can provide useful tools for the clinician while improving understanding of corticosteroid insensitivity in severe asthma.