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TYPE 2 INFLAMMATION PLAYS A
MAJOR ROLE IN THE CLINICAL
MANIFESTATION OF ASTHMA1

Optimal asthma control goes beyond exacerbation reduction

Patients with uncontrolled persistent asthma may experience impacts on their lungs and quality of life2-7

Higher
exacerbation
rates2
Impaired
lung function8-11
Potential side
effects with OCS use7,12-14
Poor quality
of life5,6

Impaired lung function contributes to risk of future severe
exacerbations and poor asthma control2,15

Lung function is critical to the assessment of future risk in patients with asthma13

  • 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 exacerbations16
  • Early and sustained improvements in lung function following therapy initiation reduced the rate and severity of future exacerbations3
There remains an unmet need to provide comprehensive care for
patients with uncontrolled persistent asthma2,13,17,18

GINA recommends considering the presence of Type 2 inflammation in patients
with severe asthma who are taking high-dose ICS or daily OCS by identifying any
one of the below13,a,b:

Blood EOS
≥150 cells/µL
and/or
sputum EOS ≥2%

and/or

FeNO
≥20 ppb

and/or

Clinically allergen-
driven asthma

and/or

OCS dependence

Consider coexisting Type 2 inflammatory diseases

Biologic add-on therapy may be a viable option for treating
certain asthma patients with Type 2 inflammation13

a The below are not the criteria for eligibility for Type 2–targeted biologic therapy.
b Patients dependent on OCS may also have underlying Type 2 inflammation; however, biomarkers of Type 2 inflammation are often suppressed by OCS. If possible, therefore, these tests should be performed before starting OCS or on the lowest possible OCS dose.

CRSwNP, chronic rhinosinusitis with nasal polyposis; EOS, eosinophils; FeNO, fractional exhaled nitric oxide; FEV1, forced expiratory volume in 1 second; ICS, inhaled corticosteroid; OCS, oral corticosteroid.

References: 1. Gandhi NA, Bennett BL, Graham NMH, Pirozzi G, Stahl N, Yancopoulos GD. Targeting key proximal drivers of type 2 inflammation in disease. Nat Rev Drug Discov. 2016;15(1):35-50. 2. 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. 3. 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. 4. 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. 5. 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. 6. Di Marco F, Verga M, Santus P, et al. Close correlation between anxiety, depression, and asthma control. Respir Med. 2010;104(1):22-28. 7. 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. 8. 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. 9. Mauad T, Bel EH, Sterk PJ. Asthma therapy and airway remodeling. J Allergy Clin Immunol. 2007;120(5):997-1009. 10. Fehrenbach H, Wagner C, Wegmann M. Airway remodeling in asthma: what really matters. Cell Tissue Res. 2017;367(3):551-569. 11. Holgate ST. The airway epithelium is central to the pathogenesis of asthma. Allergol Int. 2008;57(1):1-10. 12. 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. NHLBI Health Information Center; 2007. NIH publication 07-4051. 13. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2020. Accessed August 31, 2020. https://ginasthma.org/wp-content/uploads/2020/06/GINA-2020-report_20_06_04-1-wms.pdf 14. Rayos Prescribing Information. December 2019. 15. 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. 16. 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. 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.