Hitting the books, learning about what is new in asthma research
I had the opportunity to sit in on an update about asthma research with a world renowned pulmonologist who provided an update from the TS ( American Thoracic Society conference) to patients. I love these types of updates for a number of reasons, they are usually presented in a way that makes sense to patients and they really help to demystify snippets of information that patients are usually provided without any context.
Even if what is discussed seems like a pipe dream or things are several years from coming to market. It at least feels like there is forward momentum in asthma research. I have a lot to be thankful for, one component (eosinophils) of my asthma has had a lot of attention lately and a few things have even come to market. I have always felt that having an eosinophilic component has been a bit of a mixed blessing. While, it is responsive to corticosteroids (high dose), the side effects that come with side dose have not been so fun. There are many asthmatics out there that have less options than I do. What a perfect introduction to what I consider a buzz word right now. “Precision Medicine”. As a patient, I am excited for the possibilities of finding out exactly what drives my asthma and the development of targeted treatments I have had several doctors say that my asthma is “special”, “unique” multi faceted..etc. The next words that usually follow are” I don’t have any more that I can offer you.
For those that are asking themselves what is precision
According to the National Institutes of Health (NIH), precision medicine is “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person.” This approach will allow doctors and researchers to predict more accurately which treatment and prevention strategies for a particular disease will work in which groups of people. It is in contrast to a “one-size-fits-all” approach, in which disease treatment and prevention strategies are developed for the average person, with less consideration for the differences between individuals.
Although the term “precision medicine” is relatively new, the concept has been a part of healthcare for many years. For example, a person who needs a blood transfusion is not given blood from a randomly selected donor; instead, the donor’s blood type is matched to the recipient to reduce the risk of complications. Although examples can be found in several areas of medicine, the role of precision medicine in day-to-day healthcare is relatively limited. Researchers hope that this approach will expand to many areas of health in coming years.
Asthma research is moving in a whole new world of targeted approaches. The recent advancement of the IL-5 drugs that have come to market or are anticipated to come to market in the very near future are very exciting and are offering much more targeted approaches. I am proud to say that I have participated in research but it is always refreshing to hear stats that approx. 3-5k patients participate in clinical trial drugs before the time that they get to the FDA submission stage.
A topic that I will discuss more at another time is the inclusion/exclusion criteria for investigational drug studies. The fact that many severe asthmatics have a difficult time being accepted in clinical trials, due to the necessary but astringent inclusion criteria. Many severe asthmatics often do not have stable disease which is a requirement for trial participation.
Other hot topics included data about a fully human monoclonal antibody that inhibits the actions of both IL-4 and IL-13. It has showed immense promise and is not dependent on high blood eosinophils levels to be effective. Essentially this means that it has a larger range of patients that it can be effective for. It was also noted that blood eosinophil levels “may” not be the best way to identify patients that may benefit from this monoclonal.
While in very early investigations and still controversial is the current research being done to look at a more gentler version of Bronchial Thermoplasty (BT). Researchers are looking at ways to reach the small airways, BT currently treats the large airways. My particular case does not exactly align with BT, there was a thought it would be helpful, and a secondary thought that I would still need a high level of corticosteroids for my inflammation. Your inflammation would need to be fully controlled to be considered for BT.
In development, is a specialized CT scan that can help to identify patients who are at higher risk for substantial exacerbations. Apparently, a number of patients presented with lots of mucous plugging on their CT however reported bring up very little mucous. I am a mucous hypersecretory, I find this very interesting to know if my CT would reveal lots of mucous plugging or not. Some speciality centres are currently going through radiology training on this CT protocol.
All in all, I feel hopeful that research is making progress towards better understanding of asthma drivers, diagnosis and treatments.