Allergies, Asthma Exacerbations and Uncontrolled Asthma Management

Nicole Chase, MD; S Shahzad Mustafa, MD; Sande Okelo, MD, and Robert Sporter, MD, examine the distinct manifestations of asthma stemming from allergic and non-allergic origins, as well as the factors contributing to its exacerbation.

S Shahzad Mustafa, MD, discusses various asthma endotypes and phenotypes, considering factors such as race, age of onset, gender, BMI, and lung function test results.

The panelists explore the significance of type 2 inflammation in asthma, including its role and associated markers, while also delving into their approach to assessing patients whose asthma is triggered or worsened by allergies, examining markers beyond IgE and noting the frequency of patients presenting with asthma symptoms during allergy season without actually having allergic asthma.

The key opinion leaders deliberate on the criteria used to classify a patient as having moderate or severe asthma, as well as the factors that determine when a patient's asthma is deemed uncontrolled—including the use of combination therapy and daily symptoms.

Medical experts discuss their approach to characterizing asthma, whether they employ a dichotomous classification based on eosinophilic (EOS) or non-eosinophilic driven inflammation, or consider multiple endotypes simultaneously.

Sande Okelo, MD, explores the use of corticosteroids and the implications of their long-term use, taking into account the patient quality of life and other factors when determining which patients would derive significant benefit from corticosteroid treatment.

The panel addresses the issue of patients being exposed to high levels of oral corticosteroids (OCS) without realizing it, as various prescribers can administer steroids. They also discuss the essential questions healthcare professionals should ask to comprehend a patient's total OCS exposure and provide a definition of high OCS use.

Sande Okelo, MD, outlines the factors that contribute to the overuse of oral corticosteroids (OCS), such as nonadherence, poor inhaler technique, inappropriate prescription, and comorbidities, while also discussing strategies to limit OCS overuse and acknowledging that undertreatment can also be a significant issue.

The key opinion leaders explore the utilization of biomarkers in guiding the treatment of severe or uncontrolled asthma, discussing the specific role of eosinophils in informing therapeutic decision-making for patients with challenging asthma cases.

The expert panel discusses the use of biologics in treating asthma, explaining their mechanisms of action, differences, and target populations, while also examining trends in long-term efficacy and safety for patients with severe or uncontrolled asthma.

Sande Okelo, MD, leads a discussion on the updates in the GINA 2021 report regarding difficult-to-treat and severe asthma, as well as considerations for GINA Step 4 and 5 treatment approaches.

Medical experts discuss eligibility criteria for biologic therapies, noting that biologics can be used for other allergies and in patients with comorbidities, highlighting the potential for these targeted treatments to benefit a broad age range of patients.

Robert Sporter, MD, explores the differences in treatment approaches between adult and pediatric populations, focusing on allergy-based asthma treatments such as allergen immunotherapy and biologics, and their specific applications in managing asthma in children.

Shahzad Mustafa, MD, examines the pediatric atopic march, a phenomenon characterized by the sequential development of wheezing, asthma, and food allergies in children, discussing the progression and interrelationship of these conditions. He also explores the potential benefits of early intervention with medications in managing these conditions in pediatric patients.

Robert Sporter, MD, discusses the initial conversations he has with pediatric patients and their parents when considering biologic therapies, addressing the risks associated with not treating the condition, such as compromised lung function and increased steroid use. He emphasizes the importance of communicating a comprehensive treatment plan, including contingencies for cases where a particular therapy may not be effective.

The panel discusses the biologic drugs approved for use in children with asthma, including omalizumab, dupilumab, mepolizumab, and the recently approved benralizumab. They share their preferences among these options for improving lung function in pediatric patients.

The panel offers their final recommendations for physicians managing patients with asthma.