Analysis

Report claims the time is right to develop new treatments for severe asthma

The charity Asthma UK argues there are 'unique opportunities' to produce new treatments for severe asthma in children and young people

The charity Asthma UK argues there are 'unique opportunities' to produce new treatments for severe asthma in children and young people


Severe Asthma: the Unmet Need and the Global Challenge is a new report looking to improve
the lives of people living with severe asthma. Picture: iStock

Severe asthma can be debilitating. It destroys lives, limits activities and causes long periods away from work and school. It leads to hospital admissions and, in the most extreme cases, costs lives.

But it need not be like that – or at least that is what a new report from Asthma UK says. In a rallying cry to the asthma community, the charity says there is now a ‘unique opportunity’ to develop new treatments for severe asthma which do not respond to conventional inhalers.

The key, according to the report titled: Severe Asthma: the Unmet Need and the Global Challenge, is the rapidly improving understanding of the condition. Asthma is increasingly being seen as not just one condition, but many different types that respond differently to different treatments. Treating them requires the identification of their specific biological markers, which can then be tested for and treatment targeted at.

5.4 million

people with asthma in UK

The breakthrough has already led to a new pipeline of treatments – seven at last count – being developed for severe eosinophilic asthma. Asthma UK research director Samantha Walker says this should just be the start though. ‘The standard treatment for people living with severe asthma is the corticosteroid tablet. While these are usually effective, they are extremely toxic when taken over the long term. They can cause debilitating side effects such as mood swings, weight gain, osteoporosis and diabetes.’

But she says that is now changing. ‘We are on the cusp of new discoveries that could bring us a step closer to a cure, if we are strategic in our thinking and efforts.

‘Although research is still in its early days, it would be difficult to overstate how transformational a better understanding of these different types of asthma would be.

‘We have only begun to scratch the surface. With further investment we could see severe asthma leading a new era of personalised medicine in the NHS.’

Identifying biomarkers

Such a development could be particularly beneficial for children as, in theory, researchers could identify biomarkers that are easy to collect and measure in primary care settings, and therefore do not require invasive tests that are physically draining or involve needles.

But there is still a long way to go, the report warns. While a breakthrough has been made for eosinophilic asthma, this only accounts for about 40% of severe asthma cases. It means the rest will still have to rely on steroids for the foreseeable future.

That equates to about 150,000 people across the UK, given severe asthma affects about 250,000 of the 5.4 million people with asthma. One in five of these are children.

250,000

of the 5.4 million with asthma in the UK have severe asthma

So what needs to be done? Asthma UK has made 12 recommendations it says need to be met. These range from identifying the biomarkers and developing the treatments to treat the asthma ‘subtypes’ to convincing the pharmaceutical industry of the benefit of collaboration.

Long way to go

But it is clear there is still a long way to go. For example, some studies have already identified biomarkers specific to different sorts of severe asthma, but development has been slow because of numerous complexities, including problems testing for them. 

And what about staff on the front line? What can they do? One of the other key recommendations is a comprehensive national registry of people with severe asthma to measure the long-term impact of treatments and provide a database of potential participants for clinical trials. But respiratory nurse consultant at University Hospitals of Leicester Jane Scullion says this could prove difficult because patients are not always getting the right diagnosis and care in the first place.

‘What we find in the severe asthma clinic we run is that a large number of patients who come in with severe asthma are actually patients whose asthma is not being properly managed. Now there can be a variety of reasons for that, such as co-morbidities and psychological reasons, or they may simply not have been given the right support. But I would not rush to assume it is always a case of their asthma not being able to be treated.’

60%

of the 250,000 rely on steroids because of a lack of treatment options

Instead, she says any push for new treatments must also be accompanied by renewed efforts to help people manage asthma themselves. ‘There are relatively new guidelines which stress the need to use the preventive inhaler rather than the reliever we have perhaps relied on in the past.

'We are only just getting that right and we need to continue to work with that to support patients. It is particularly important for children because, if they get their asthma under control, there’s a good chance that continues into adulthood.’

A new era for eosinophilic asthma?

There are seven treatments that have been developed or are in development for eosinophilic asthma thanks to the breakthrough in understanding about the particular traits of this version of the condition.

A treatment developed by Novartis, omalizumab, is already available on the NHS, while another therapy, mepolizumab, produced by GSK, was approved for use from April.

A third treatment, reslizumab, is currently being reviewed by the National Institute for Health and Care Excellence, while a fourth, benralizumab, is awaiting European Medicines Agency marketing authorisation, which is expected to come later this year.

A further three are in the latter stages of clinical trials. These are tralokinumab, dupilumab and fevipiprant.

Eosinophilic asthma effects an estimated 100,000 people in the UK, according to Asthma UK.

Living with severe asthma

Lehanne Sergison was diagnosed with asthma before she started school and since her early teenage years the condition has been severe.

‘Every four to six weeks, from about 13 years old, I have had to be admitted to hospital,’ she says.

Despite this she managed to complete her education and qualified as a chartered surveyor, but at the age of 40 she had to medically retire, she is now 46.

‘Asthma has stopped me from doing the things I love – the job I can no longer do, flying is not possible so travelling is restricted and I have never been able to play sport.

‘I am now on over 20 different medicines, including high dose oral corticosteroids which I have been taking since I was 14. This has had serious impacts to my health. I have had to have a hip replacement and I now have diabetes, epilepsy, high blood pressure, high cholesterol, herniated discs, reflux, in addition to weight gain and stretch marks.

‘Severe asthma has had a big effect on my life, I have been ventilated 13 times and have been very unwell on lots of other occasions. It has caused other health conditions, affected my career, friendships and relationships, causing a lot of worry and stress.’

 

Severe asthma: the unmet need and the global challenge


Nick Evans is a health writer

This article is for subscribers only

Jobs