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Optimal Asthma Control
Goes Beyond Exacerbation Reduction

 

Patients with uncontrolled persistent asthma may experience
higher exacerbation rates, impaired lung function, risk of long-term
OCS side effects, and poor quality of life1-6

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Higher exacerbation rates
Higher exacerbation rates
  • Exacerbations were 3 times more likely to occur
    in patients with uncontrolled asthma rates than in those
    with better asthma control1
 
Impaired lung function
Impaired lung function
  • Reversible airway obstruction in uncontrolled asthma is caused by bronchoconstriction and mucus production7-10
  • Airway remodeling, often driven by persistent Type 2 inflammation, can lead to impaired lung function in both the large and small airways7-10
 
Potential side effects with OCS
Potential side effects with OCS
  • Due to the potential for substantial side effects
    with OCS use, guidelines suggest not using OCS as
    maintenance therapy until all other pharmacologic
    options have been exhausted11,12
  • Long-term use of OCS has been associated with
    osteoporosis, arterial hypertension, diabetes and
    metabolic syndrome, dyslipidemia, obesity,
    cataracts, glaucoma, gastrointestinal bleeds/ulcers,
    tuberculosis, depression, herpes, and sepsis6,13
 
Poor QoL
Poor QoL
  • Patients miss out on outdoor, physical, and other
    daily activities4
  • Anxiety and depression worsen symptoms
    and complicate disease management5
 

Impaired lung function contributes to risk of future severe
exacerbations and poor asthma control1,14

Lung function is critical to the assessment of future risk in patients with asthma12

  • Patients with frequent exacerbations and moderate-to-severe asthma experienced
    a significantly greater annual decline in FEV1 in a long-term study, compared with patients
    who had infrequent exacerbations15
  • Early and sustained improvements in lung function following therapy initiation reduced
    the rate and severity of future exacerbations16

Lung function should be measured as part of the assessment of asthma control12:

  • At the start of treatment
  • After 3 to 6 months of treatment
  • Periodically thereafter for ongoing risk assessment
There remains an unmet need to provide
comprehensive care for patients with
uncontrolled persistent asthma
1,12,17,18

FEV1, forced expiratory volume in 1 second; OCS, oral corticosteroids; QoL, quality of life.

References:
  1. Haselkorn T, Fish JE, Zeiger RS, et al; TENOR Study Group. Consistently very poorly controlled asthma, as defined by the impairment domain of the Expert Panel Report 3 guidelines, increases risk for future severe asthma exacerbations in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. J Allergy Clin Immunol. 2009;124(5):895-902.
  2. O'Byrne PM, Pedersen S, Lamm CJ, Tan WC, Busse WW; START Investigators Group. Severe exacerbations and decline in lung function in asthma. Am J Respir Crit Care Med. 2009;179(1):19-24.
  3. Nguyen VQ, Ulrik CS. Measures to reduce maintenance therapy with oral corticosteroid in adults with severe asthma. Allergy Asthma Proc. 2016;37(6):125-139.
  4. Haselkorn T, Chen H, Miller DP, et al. Asthma control and activity limitations: insights from the Real-world Evaluation of Asthma Control and Treatment (REACT) Study. Ann Allergy Asthma Immunol. 2010;104(6):471-477.
  5. Di Marco F, Verga M, Santus P, et al. Close correlation between anxiety, depression, and asthma control. Respir Med. 2010;104(1):22-28.
  6. Sullivan PW, Ghushchyan VH, Globe G, Schatz M. Oral corticosteroid exposure and adverse effects in asthmatic patients. J Allergy Clin Immunol. 2018;141(1):110-116.
  7. Elliot JG, Jones RL, Abramson MJ, et al. Distribution of airway smooth muscle remodelling in asthma: relation to airway inflammation. Respirology. 2015;20(1):66-72.
  8. Mauad T, Bel EH, Sterk PJ. Asthma therapy and airway remodeling. J Allergy Clin Immunol. 2007;120(5):997-1009.
  9. Fehrenbach H, Wagner C, Wegmann M. Airway remodeling in asthma: what really matters. Cell Tissue Res. 2017;367(3):551-569.
  10. Holgate ST. The airway epithelium is central to the pathogenesis of asthma. Allergol Int. 2008;57(1):1-10.
  11. National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma—Full Report 2007. Bethesda, MD: NHLBI Health Information Center; 2007. NIH publication 07-4051.
  12. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2018. http://ginasthma.org/2018-gina-report-global-strategy-for-asthma-management-and-prevention/. Accessed March 8, 2018.
  13. Rayos Prescribing Information. September 2017.
  14. Patel M, Pilcher J, Reddel HK, et al; SMART Study Group. Predictors of severe exacerbations, poor asthma control, and β-agonist overuse for patients with asthma. J Allergy Clin Immunol Pract. 2014;2(6):751-758.
  15. Bai TR, Vonk JM, Postma DS, Boezen HM. Severe exacerbations predict excess lung function decline in asthma. Eur Respir J. 2007;30(3):452-456.
  16. O'Byrne PM, Pedersen S, Lamm CJ, Tan WC, Busse WW; START Investigators Group. Severe exacerbations and decline in lung function in asthma. Am J Respir Crit Care Med. 2009;179(1):19-24.
  17. Agache I, Akdis C, Jutel M, Virchow JC. Untangling asthma phenotypes and endotypes. Allergy. 2012;67(7):835-846.
  18. Bjermer L. Time for a paradigm shift in asthma treatment: from relieving bronchospasm to controlling systemic inflammation. J Allergy Clin lmmunol. 2007;120(6):1269-1275.
  19. Wenzel SE. Emergence of biomolecular pathways to define novel asthma phenotypes: type-2 immunity and beyond. Am J Respir Cell Mol Biol. 2016;55(1):1-4.
  20. Robinson D, Humbert M, Buhl R, et al. Revisiting type 2-high and type 2-low airway inflammation in asthma: current knowledge and therapeutic implications. Clin Exp Allergy. 2017;47(2):161-175.
  21. Ray A, Raundhal M, Oriss TB, Ray P, Wenzel SE. Current concepts of severe asthma. J Clin Invest. 2016;126(7):2394-2403.
 

Is there more to asthma than allergic and eosinophilic phenotypes?

Get a clearer picture of patients with asthma driven by Type 2 inflammation

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Patients with uncontrolled persistent asthma lack comprehensive care

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Type 2 inflammation
in asthma

encompasses eosinophilic and
allergic phenotypes and occurs
in ~50%a to 70%b of adult
patients with asthma1-4
  • IL-4, IL-13, and IL-5 are key drivers of Type 2 inflammation in asthma1
  • IL-4 and IL-13 are central Type 2 cytokines with distinct and overlapping roles1
Heterogeneous and
complex:

Type 2 inflammation in asthma
may be difficult to diagnose1,2,5
  • Use of serum IgE levels and blood eosinophils alone as asthma biomarkers may fail to accurately characterize the broad spectrum of Type 2 inflammation in asthma6,7
  • Reliance on only a narrow range of biomarkers may leave patients with Type 2 asthma suboptimally controlled6,7
Optimal asthma control
goes beyond exacerbation reduction
  • Early and sustained improvements in lung function and following therapy initiation reduced the rate and severity of future exacerbations8
  • Improving lung function is a goal of optimal asthma management9

aN=205.
bN=37.

References:
  1. Robinson D, Humbert M, Buhl R, et al. Revisiting type 2-high and type 2-low airway inflammation in asthma: current knowledge and therapeutic implications. Clin Exp Allergy. 2017;47(2):161-175.
  2. Wenzel SE. Emergence of biomolecular pathways to define novel asthma phenotypes: type-2 immunity and beyond. Am J Respir Cell Mol Biol. 2016;55(1):1-4.
  3. Seys SF, Scheers H, Van den Brande P, et al. Cluster analysis of sputum cytokine-high profiles reveals diversity in T(h)2-high asthma patients. Respir Res. 2017;18(1):39. doi:10.1186/s12931-017-0524-y
  4. Peters MC, Mekonnen ZK, Yuan S, Bhakta NR, Woodruff PG, Fahy JV. Measures of gene expression in sputum cells can identify TH2-high and TH2-low subtypes of asthma. J Allergy Clin Immunol. 2014;133(2):388-394.
  5. Ray A, Raundhal M, Oriss TB, Ray P, Wenzel SE. Current concepts of severe asthma. J Clin Invest. 2016;126(7):2394-2403.
  6. Albers FC, Müllerová H, Gunsoy NB, et al. Biologic treatment eligibility for real-world patients with severe asthma: the IDEAL study. J Asthma. 2018;55(2):152-160.
  7. Korevaar DA, Westerhof GA, Wang J, et al. Diagnostic accuracy of minimally invasive markers for detection of airway eosinophilia in asthma: a systematic review and meta-analysis. Lancet Respir Med. 2015;3(4):290-300.
  8. O’Byrne PM, Pedersen S, Lamm CJ, Tan WC, Busse WW; START Investigators Group. Severe exacerbations and decline in lung function in asthma. Am J Crit Care Med. 2009;179(1):19-24.
  9. Nguyen VQ, Ulrik CS. Measures to reduce maintenance therapy with oral corticosteroid in adults with severe asthma. Allergy Asthma Proc. 2016;37(6):125-139.