Treatment Options for Patients With Severe Asthma

Asthma is an airway disease that affects approximately 25 million people in the United States.¹ Although the majority of patients respond to standard therapy of low or moderate doses of inhaled corticosteroids (ICS), 5-10% of patients remain uncontrolled despite escalating therapy. Uncontrolled severe asthma has been estimated to affect 2 million people in the United States and accounts for nearly 50% of asthma-related health care costs. Severe asthma is not only a burden on health care use and costs, but also significantly impacts a patient’s quality of life.

In a recent review, Blaiss et al. discussed the challenges surrounding the diagnosis and management of severe asthma.¹ Their review aimed to establish a unified definition for severe asthma, assess biomarker testing and phenotype-based care, and develop guidelines surrounding biologic therapies and bronchial thermoplasty.  The authors defined severe asthma as “asthma that, despite patient adherence, requires high-dose ICS plus LABA [long-acting β₂-agonist] and/or additional controller medication or requires oral corticosteroids (OCSs) to prevent it from becoming uncontrolled or that remains uncontrolled despite this therapy.” 

Blaiss et al. also discussed the role of biomarker testing and a phenotype-based treatment approach in the management of severe asthma in their review.¹ Unlike the Global Initiative for Asthma guidelines which recommend phenotyping asthma when it becomes challenging to treat, the authors suggest determining an asthma patient’s phenotype at diagnosis. Moreover, current treatment guidelines utilize a stepwise approach to assist in managing increasingly difficult-to-treat symptoms. Blaiss et al, however, suggest that treatment of severe asthma should be guided by the asthma phenotype of a specific patient. Table 1 summarizes the recommended biomarker tests for asthma phenotyping while Figure 1 and Table 2 provide overviews of the management of severe asthma using a phenotype-based approach.

Severe asthma proves to be a challenging condition for both patients and providers.¹ To help address the unmet medical needs of patients with severe asthma, Blaiss et al recommend utilizing biomarker testing and a phenotype-guided treatment approach. Available therapeutic options for severe asthma include tiotropium, omalizumab, interleukin-5 targeted therapies, macrolide antibiotics, and bronchial thermoplasty.

References:

1. Blaiss MS, Castro M, Chipps BE, Zitt M, Panettieri RA, Foggs MB. Guiding principles for use of newer biologics and bronchial thermoplasty for patients with severe asthma. Ann Allergy Asthma Immunol. 2017; 119(6):533-540.

2. Monthly Prescribing Reference: Fasenra Rx Web site. https://www.empr.com/fasenra/drug/34769/ Accessed February 2, 2018.