Difficult-to-treat asthma or severe asthma is a type of asthma that does not respond well to standard treatment with inhaled medications. It is estimated that around 5-10% of people with asthma have difficult-to-treat asthma.
In difficult-to-treat asthma, the airways may be more inflamed, constricted, or hyperreactive than in other types of asthma. This can lead to more frequent and severe asthma attacks, even with regular use of medications. Difficult-to-treat asthma may be caused by a combination of genetic and environmental factors, as well as comorbid conditions such as allergies, sinusitis, or gastroesophageal reflux disease (GERD).
Management of difficult-to-treat asthma often involves a comprehensive approach that goes beyond standard asthma medications. Here are some of the strategies that may be used:
Identifying and addressing triggers:
Patients may undergo testing to identify triggers for their asthma, such as allergens or irritants. Strategies for reducing exposure to these triggers can be developed.
Using combination therapies:
Patients with difficult-to-treat asthma may be prescribed a combination of medications, such as inhaled corticosteroids and long-acting bronchodilators, or biologic agents that target specific inflammatory pathways.
Monitoring and adjusting treatment:
Patients with difficult-to-treat asthma may require more frequent monitoring and adjustments to their treatment plan, based on symptoms, lung function, and other factors.
Treating comorbid conditions:
Patients may be evaluated for comorbid conditions that can worsen asthma, such as allergies, sinusitis, GERD, or sleep apnea. Treatment of these conditions can help improve asthma control.
Referral to a specialist:
Patients with difficult-to-treat asthma may be referred to a specialist, such as a pulmonologist or allergist, who has expertise in managing complex asthma cases.
It's important to note that managing difficult-to-treat asthma can be challenging and may require a trial-and-error approach to find the most effective treatment plan for each individual patient. Patients with difficult-to-treat asthma should work closely with their healthcare provider to develop a personalized management plan.
Biologics in severe asthma management-
Biological medications, also known as biologics, are a newer class of medications that have shown promise in treating severe asthma. Biologics are targeted therapies that work by blocking specific inflammatory pathways involved in asthma. They are usually given by injection or infusion and are reserved for patients with severe, uncontrolled asthma who have not responded well to other medications.
Here are some of the biologics that are currently approved for treating severe asthma:
Omalizumab:
Omalizumab is a monoclonal antibody that targets immunoglobulin E (IgE), a protein that plays a role in allergic reactions. It is used to treat severe allergic asthma and is given by injection every two to four weeks.
Mepolizumab:
Mepolizumab is a monoclonal antibody that targets interleukin-5 (IL-5), a protein that plays a role in the production of eosinophils, a type of white blood cell involved in allergic inflammation. It is used to treat severe eosinophilic asthma and is given by injection every four weeks.
Reslizumab:
Reslizumab is another monoclonal antibody that targets IL-5 and is used to treat severe eosinophilic asthma. It is given by infusion every four weeks.
Benralizumab:
Benralizumab is a monoclonal antibody that targets the alpha subunit of the IL-5 receptor and is used to treat severe eosinophilic asthma. It is given by injection every four weeks for the first three doses and then every eight weeks thereafter.
Dupilumab:
Dupilumab is a monoclonal antibody that targets interleukin-4 (IL-4) and interleukin-13 (IL-13), two proteins that play a role in the immune response. It is used to treat severe asthma with type 2 inflammation and is given by injection every two weeks.
Biologics can help reduce inflammation in the airways and improve asthma control, but they are not effective for all patients with severe asthma. Patients who are considering biologics should be evaluated by a specialist and undergo testing to determine whether they are a good candidate for these medications. Biologics can also have side effects, so patients should be monitored closely during treatment.
