Shifting the Treatment Paradigm of Severe Asthma With Novel Biologics - Episode 16

Looking Forward in Asthma Treatment

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The panel provides their final thoughts on the treatment of asthma and what they see and hope for in the future.

Reynold Panettieri, Jr, MD: I’d like to get some final comments. I want to start with professor Chupp. Geoff, where’s the wisdom?

Geoffrey Chupp, MD: Well, I’m going to have to dig deep to find wisdom, Rey. But I will say that I think this has been a fantastic discussion. I really enjoyed everyone’s insight and your moderation of the discussion. The 1 thing I will say is that I think we will have an opportunity to see a modification of the disease in our lifetime. I believe that there’s a chance we’re going to be able to change progression of the disease. As we know, some of these may be early-life trials, and even if you catch the patient soon enough after this injury or whatever the sentinel moment is for people to develop asthma—whether it’s early in life or as an adult—if we can reverse that, we have a chance of curing the disease. The drugs we have now and our understanding of endotypes is really making me hopeful that we’re going to achieve this at some point in the next few decades.

Reynold Panettieri, Jr, MD: That would be fantastic. That’s what we’re in the business of doing. We would love to see a cure, or at least decreased susceptibility for your reversible airflow obstruction. Nic, parting comments?

Nicola Hanania, MD, MS: It’s really hard to add more comments. I’m hoping—I may not be as optimistic—that we will see it in our lifetime. I hope I live long enough to do so. But I think we’ve taken good strides in asthma. We’re now thinking outside the box. We’ve really changed our approach from a “one-size-fits-all” disease. We know how to do phenotyping. We know that asthma affects multiple groups of patients. This generalistic approach is changing slowly, but it is changing. We’re seeing this on the other hand with the patients’ outcomes. We’re seeing better control. I can tell you that in the ICU [intensive care unit] of our hospital, Baylor College of Medicine in Houston, Texas, we’re seeing less admissions in the last 5 to 10 years compared to what we have seen when I first started 25 years ago. There is definitely an outcome improvement in whatever we’re doing in asthma—the guidelines, the treatments, the approach, and the thinking of the disease. I am hoping we’ll see 1-time interventions that can change that natural history that I was talking about earlier.

Reynold Panettieri, Jr, MD: Well, if you remember—at least I remember—when I started out in the space of asthma, asthma mortality was an epidemic. There was a red flag and there were flashing lights saying we were losing in asthma. There was an increased death rate and that death rate was in a diverse population, unfortunately. But we’re seeing marked improvements. Death rate is almost unheard of from asthma now. What a wonderful outcome. Sid, you have the last words.

Sidney Braman, MD: Well, you almost took the last words out of my mouth. Nic was reflecting on the last 5 to 10 years. I was going to reflect on the last 30 years. In 1991, the first guideline came out, the NAEPP [National Asthma Education and Prevention Program] guideline. You’re absolutely right. Prior to that time, despite the fact that we were doing things we thought were safer with asthma: we weren’t giving intravenous aminophylline, we weren’t giving ephedrine across the blood-brain barrier, and we were giving more beta-2 specific agents. In the ICU, we were focusing on hypercapnia and not marrow trauma, and all the wonderful things we were doing. Mortality kept going up, up, and up. I think the final word is that we’ve spoken about maybe 5% to 10% of what we call “the severe asthmatic” today. But what about all those other individuals out there with asthma who we’ve helped so much and have had asthma relief? As you just mentioned, asthma mortality now is quite rare. I think that we need to look at the positive side: those extra 90% or so patients that we didn’t really concentrate on today, have done quite well.

Reynold Panettieri, Jr, MD: Well, on behalf of Sid, Geoff, Nic, and I, thank you, you’ve hung in there. Thank you for watching this HCP Live® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchanges and other great content right in your inbox. It comes to you wherever you’re at: on your phone, in your office, or in your home. I want to thank everyone and our sponsors for this wonderful opportunity. Have a wonderful day and be safe. Thank you.

Transcript Edited for Clarity