Asthma Center

Asthma Control in Patients Receiving Advanced Therapies for Severe Asthma With Eosinophilia

Approximately 10% of patients with asthma have severe asthma, defined by the need for high-dose inhaled steroids or oral steroids, either to maintain control or despite which asthma control is still not achieved. ¹ In this group, even with optimal therapy, patients experience ongoing symptoms and have higher healthcare utilization. Therapies for severe asthma have significantly advanced in recent years. The Asthma Center uses a personalized approach based on the type of asthma (often referred to as asthma phenotype or endotype). Individuals with or without allergies may have a form of asthma called eosinophilic asthma, which results in significant symptoms and often requires high doses of medications, including even oral steroids.

To monitor patients closely for therapeutic response to biologics, the Asthma Center providers enroll patients in a registry. The center has > 300 patients enrolled in the registry for various biologics.²⁻⁸

In 2022, a greater number of severe asthmatics were treated with mepolizumab in our practice. The use of mepolizumab was associated with improvement of asthma control and decrease in the use of oral steroids.

Podcasts

Cleveland Clinic Respiratory Institute hosts podcasts available on Apple, Google, Soundcloud and Spotify. Click on the link below to find and listen to ‘Progress in Management of Asthma’ hosted by Sumita Khatri, MD, with guests Emily Pennington, MD, and Roxana Siles, MD, FACAAI, FAAAAI.

Respiratory Inspirations. Suitable for any audience interested in learning more about conditions affecting your respiratory health as we discuss related diseases, causes, treatments, innovations and what the future may bring. Visit: https://my.clevelandclinic.org/podcasts/respiratory-inspirations

Improvement in ACT Scores for Patients with Severe Eosinophilic Asthma Treated With Mepolizumab

2022

ACT = Asthma Control Test

In the cohort of 136 patients with severe asthma who were treated with mepolizumab, the median ACT score significantly improved at follow-up (P=0.0002 from 0 to 3 months and P=0.0125 from 0 to 6 months).

Percent of Patients Requiring Chronic Oral Steroid Administration While Receiving Mepolizumab (N = 136)

2022

Utilization of oral corticosteroids for treating severe asthma is a source of morbidity from side effects and additional health risks. Asthma Center analysis demonstrates that patients’ need for oral steroids significantly decreased with therapy (P < 0.001).

These outcomes data demonstrate that comprehensive evaluation and multidisciplinary management of patients presenting to the Asthma Center improve asthma control even in the most severe cases. Rigorous monitoring and adjustments of therapies are needed as patients improve or require alternative advanced therapies available.⁹⁻¹⁰

References

  1. Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014 Feb;43(2):343-373.
  2. Ortega HG, Liu MC, Pavord ID, Brusselle GG, FitzGerald JM, Chetta A, Humbert M, Katz LE, Keene ON, Yancey SW, Chanez P; MENSA Investigators. Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med. 2014 Sep 25;371(13):1198-1207.
  3. Bleecker ER, FitzGerald JM, Chanez P, Papi A, Weinstein SF, Barker P, Sproule S, Gilmartin G, Aurivillius M, Werkström V, Goldman M; SIROCCO study investigators. Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial. Lancet. 2016 Oct 29;388(10056):2115-2127.
  4. Nair P, Wenzel S, Rabe KF, Bourdin A, Lugogo NL, Kuna P, Barker P, Sproule S, Ponnarambil S, Goldman M; ZONDA Trial Investigators. Oral glucocorticoid-sparing effect of benralizumab in severe asthma. N Engl J Med. 2017 Jun 22;376(25):2448-2458.
  5. Castro M, Corren J, Pavord ID, et al. Dupilumab efficacy and safety in moderate-to-severe uncontrolled asthma. N Engl J Med. 2018 Jun 28;378(26):2486-2496.
  6. Busse W, Corren J, Lanier BQ, McAlary M, Fowler-Taylor A, Cioppa GD, van As A, Gupta N. Omalizumab, anti-IgE recombinant humanized monoclonal antibody, for the treatment of severe allergic asthma. J Allergy Clin Immunol. 2001 Aug;108(2):184-190.
  7. Solèr M, Matz J, Townley R, Buhl R, O'Brien J, Fox H, Thirlwell J, Gupta N, Della Cioppa G. The anti-IgE antibody omalizumab reduces exacerbations and steroid requirement in allergic asthmatics. Eur Respir J. 2001 Aug;18(2):254-261.
  8. Wenzel S, Ford L, Pearlman D, Spector S, Sher L, Skobieranda F, Wang L, Kirkesseli S, Rocklin R, Bock B, Hamilton J, Ming JE, Radin A, Stahl N, Yancopoulos GD, Graham N, Pirozzi G. Dupilumab in persistent asthma with elevated eosinophil levels. N Engl J Med. 2013 Jun 27;368(26):2455-2466.
  9. 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group
  10. Brusselle, GG and Koppelman, GH. Biologic Therapies for Severe Asthma. NEJM. 2022 Jan; 386:157-171.