Asthma is one of the most prevalent long term conditions in the UK, affecting 5.4 million people, of whom nearly three million take treatment. According to Asthma UK, it costs the NHS £1.1 billion per year in GP visits, hospital care and state benefits, with £650 million of this total spent on prescription drugs.
It is estimated that 5 to 10% of all asthma patients have severe asthma and need to take multiple medications to control their day-to-day symptoms and reduce the risk of frequent and serious asthma attacks. While there has been significant progress made in the treatment of respiratory conditions, including asthma, these diseases still impact the lives of nearly 700 million people world-wide, which is similar to the population of Europe*.
There is currently no cure for asthma, and despite medical advances, more than half of the people diagnosed with the condition continue to experience poor control and significant symptoms, impacting their lives every day.
Despite the fact that treatment options for people with severe asthma are extremely limited, according to the experts, there are now some “revolutionary, and often life changing, therapies” emerging for selected patients suffering with severe asthma.
Advances in severe asthma
Dr Samantha Walker, Director of Research and Policy at Asthma UK, says: “There are currently an estimated 250,000 people in the UK with a diagnosis of severe asthma, which means that regular asthma treatments don’t work for them.”
Dr Walker says that most severe asthma patients rely on high-dose oral steroids which can have serious side effects. “Even with these medications, their asthma is hard to control,” she adds. Advances however mean that there is hope for some of those with the most severe form of the condition. “The latest types of medicine used to treat it are monoclonal antibodies – known as ‘MABs’ – such as Xolair (omalizumab) which has been available for some time, and newer ones such as Nucala (mepolizumab) and Cinqaero (reslizumab).”
Dr Walker says that there is now a need to urgently identify treatments for all of those with severe asthma. “We hear from people with severe asthma that these treatments can be life-changing. However, it is becoming clear that asthma is not one condition but many and not all MABs will be effective for all of them. Urgent research is needed to understand the biology of asthma, work towards more treatments and ultimately find a cure.”
When the main treatments for asthma such as preventer and reliever inhalers, steroid and non-steroid tablets, and injectable steroids don’t work, those with severe asthma need further options.
Dr Andrew Thornber, Chief Medical Officer at Now Patient (nowpatient.com, a leader in the tele-pharmacy space, which supplies asthma medication via app to people needing repeat prescriptions), says: “New treatments for asthma are constantly being researched and developed. Recent advances in injectable biologics and smart medical devices have led to an increase in new ways to treat severe asthma.”
There are significant developments in the field. “The management of mild to moderate asthma has evolved in line with clinical research, is generally reflected in clinical guidelines and is, in general, incremental. In severe asthma we have potentially transformational change,” says John Haughney, Clinical R&D, NHS Greater Glasgow & Clyde. “Effective use of medicines in people with asthma is confounded by issues around the correct use of inhaler devices. ‘E-halers’, which offer feedback on inhaler use to patients and potentially their clinicians, are becoming available: drug delivery is inextricably linked with pharmacological treatment.”
According to Haughney, support is increasing for the use of so called ‘anti-inflammatory reliever therapy’: “Fixed combination therapy products permit the delivery of both bronchodilator and anti-inflammatory therapy, avoiding the dangers of reliever overuse.”
The advances in the treatment of severe asthma are “life-changing” for patients, Haughney says: “In severe asthma, there is transformational change. Led by the traditional respiratory houses, biologic therapies have or are being introduced. Novartis’ anti IgE therapy Xolair is well established; GSK, Teva and AZ have released anti-IL5 therapies, mepolizumab, reslizumab and benrulizumab. Other novel and exciting therapies such as Sanofi’s diplulimab may be available shortly,” he explains. “These are expensive therapies and require careful selection of suitable patients through identification of biomarkers in addition to clinical need to justify prescribing. So in asthma management we have in part useful modifications to traditional approaches and revolutionary, and often life-changing, therapies for selected patients.”