Clinical Issues in Severe Asthma: Debates and Discussions About Personalizing Patient Management

An outsized proportion of asthma-related morbidity and mortality is borne by the 5% to 15% of affected patients who have severe forms of the disease.1,2 These patients suffer from poorly controlled symptoms and frequent exacerbations, often despite daily treatment with high-dose inhaled corticosteroids and other long-acting controller medications.1,2 Ongoing research has elucidated key pathophysiologic processes and other clinical parameters related to asthma severity and persistence.2,3 In many cases, the patient’s medical history, clinical presentation, and results from biomarker testing can help classify severe asthma phenotypically.2,3 Increasingly, this can allow physicians to personalize maintenance regimens using targeted therapies that reflect identified endotypes—ie, asthma phenotypes linked to specific underlying disease mechanisms and proinflammatory signaling cascades.2,4,5 Several biologic medications are now available to treat certain cohorts with severe asthma, and a number of other targeted agents are in late-stage development.5-7 Pulmonologists and other asthma specialists who manage patients with severe asthma need to stay current on the latest published trial data for newer targeted therapies, approvals from the US Food and Drug Administration, and actionable best-practice recommendations on evaluating and treating patients with severe asthma. During this web-based Clinical Issues™ program, a panel of expert faculty will discuss and debate a series of topics related to comprehensively evaluating and longitudinally managing patients with severe asthma, including how the evolving evidence base should shape clinical decision-making and implications of new study data presented at the 2018 American Thoracic Society International Conference.

References

1. Levy ML. The national review of asthma deaths: what did we learn and what needs to change? Breathe (Sheff). 2015;11(1):14-24.

2. Chung KF, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43(2):343-373.

3. Wan XC, Woodruff PG. Biomarkers in severe asthma. Immunol Allergy Clin North Am. 2016;36(3):547-557.

4. Lötvall J, et al. Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome. J Allergy Clin Immunol. 2011;127(2):355-360.

5. Fajt ML, Wenzel SE. Asthma phenotypes and the use of biologic medications in asthma and allergic disease: the next steps toward personalized care. J Allergy Clin Immunol. 2015;135(2):299-310.

6. Bousquet J, et al. Care pathways for the selection of a biologic in severe asthma. Eur Respir J. 2017;50(6):1701782.

7. Walsh GM. Biologics targeting IL-5, IL-4 or IL-13 for the treatment of asthma—an update. Expert Rev Clin Immunol. 2017;13(2):143-149.