An asthma inhaler allows patients with a milder disease to go about their daily lives with little to no complications, but patients with more severe asthma or comorbidities often experience symptoms that warrant more advanced therapy.
“Patients that have daily symptoms—wheezing, chest discomfort, frequent coughing, and shortness of breath—have a very poor quality of life,” said Diego J. Maselli, MD, FCCP, a specialist in critical care medicine, internal medicine, and pulmonary disease at University of Texas Health Science Center at San Antonio. “They cannot do the things they want. They cannot do sports, and they have a hard time having a regular workday because their symptoms interfere with their life.”
The case-based session What Else Can I Do for My Asthma? A Focus on Advanced Therapies on Monday at 3:15 pm in room 212AB of the convention center, will explore other treatment options available to patients beyond the regular inhalers.
Some of those therapies include monoclonal antibodies, anticholinergics, phosphodiesterase inhibitors, and bronchial thermoplasty, said Dr. Maselli, chair of the session. There are currently four monoclonal antibodies approved by the FDA, and there could be a fifth one approved late this year. Clinicians use biomarkers, or “treatable traits,” to tailor therapy and determine which treatment to use, he added, which will be reviewed in the session.
“For example, we might evaluate the number of eosinophils in the peripheral blood. Any patients that have a high number of these cells might potentially tell us that these cells are activated and may be influencing the asthma control,” Dr. Maselli said. “We have a medication that would then block this inflammation. On the other hand, if you have high levels of IgE (immunoglobulin E), we also have a medication that would neutralize this molecule and then would improve asthma.”
At times, patients have no present or elevated biomarkers, which means they would likely not benefit from those specific advanced therapies, Dr. Maselli said, and the clinician would explore other treatment options.
It’s important to determine the correct therapy because patients that have frequent exacerbations often wind up in the ER or hospitalized. The session also will address treating patients with comorbid conditions—for example, acid reflux disease, sleep apnea, and obesity—that can affect asthma control.
“This is a really exciting time for asthma care,” Dr. Maselli said. “Within pulmonary medicine, asthma and asthma care in general are ahead of many diseases because we can have a little more precision medicine when it comes to therapy. There’s still things we need to learn, and the medications are not always perfect, but we’re refining that.”