A Breath of Fresh Air: Novel Treatments for Asthma

Asthma, characterized by chronic airway inflammation, currently affects more than 300 million people globally.

Common asthma-related symptoms include chest tightness, shortness of breath, wheezing, and coughing. New analyses have brought specific subtypes that share phenotypic characteristics to light. Novel therapies such as monoclonal antibodies and phenotype-guided treatments are available and clinicians are using them to help patients with severe asthma.

An article published March 2018 in the journal Breathe touches upon some new treatment options available.

Omalizumab, a monoclonal antibody, binds and inhibits immunoglobulin E (IgE). IgE plays a role in the pathophysiology of the allergic inflammation characteristic of asthma. Omalizumab's inhibition of IgE down-regulates the immune response to gain control over the allergy-driven inflammation component.

The FDA has approved omalizumab as an add-on therapy for patients older than 6 years with severe persistent allergic asthma who remain uncontrolled with a corticosteroid and a long-acting beta-agonist (LABA). Recent studies have shown that omalizumab provided significant control over asthma symptoms, with a 30% reduction in inhaled corticoid steroid (ICS) use and a total discontinuation of systemic corticoid steroid use.

Eosinophilic inflammation often has a role in asthma as well, with interleukin-5 (IL-5) being a major cytokine responsible for eosinophil proliferation. The FDA has approved 2 monoclonal antibodies that inhibit IL-5, mepolizumab and reslizumab, for patients aged 12 years and older with severe eosinophilic asthma that is uncontrolled on corticoid steroids and a LABA. Patients treated with either mepolizumab or reslizumab had reduced asthma exacerbations and steroid use, with overall improved asthma control and quality of life.

The ability to phenotype patients suffering from asthma has identified new treatment options. However, despite these novel agents’ efficacy, it is important to consider using them only in cases of severe uncontrolled asthma. Providers should always assess the patient’s inhaler technique, medication adherence, and other modifiable risk factors before starting one of these therapies.

Connor Walker is a 2018 PharmD Candidate at the University of Connecticut.

Reference

Delimpoura V, Bonstantzoglou C, Liu N, Nenna R. Novel therapies for severe asthma in children and adults. Breathe (Sheff). 2018 Mar;14(1):59-62.