Page 133 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
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rth Dilemma: Age. How Old Fifth Dilemma: Length of Treatment 133
(or Young) Should Our Patients Appropriate to Assess a Patient’s
be for Indication for Biologicals? Response to Biologicals (“Responder” controversies and dilemmas in severe asthma
or “Non-responders”)
Allergic asthma is usually an early-on-
set (during childhood, before the age of 12 We do not have a universally accepted defini-
years), but not necessarily, while eosinophil- tion of response to biologicals in severe asth-
ic asthma is usually a late-onset, but also not ma. There is no one parameter most impor-
necessarily. In children, after the age of 6 tant in an evaluation. Most experts agree that
years, omalizumab showed good tolerability it is necessary to assess different asthma el-
and safety, while anti-IL-5 treatment mepoli- ements during follow-up, from the clinical
zumab and benralizumab are recommended point (frequency of exacerbations, symptom
after the age of 12 years (reslizumab after the score), lung function, therapy dosages that
age of 18), as well as dupilumab with the in- patients need to control asthma symptoms,
dication for severe asthma46. Registries of se- as well as inflammatory biomarkers values49.
vere asthma patients show that the average In the present-day perspective, it is also essen-
age of severe asthma patients receiving bio- tial to have shared decision making. The im-
logicals is older than 50 years, with a median portance of a conversation should be empha-
of 56 years (with the oldest patient at the age sized, which will define the patient’s goals in
of 83 years)47. In the group of late-onset se- biological treatment–that together,the patient
vere asthma, there is also a group of patients and his physician should decide what the asth-
with a “Non-T2 high” phenotype. They have matic person would like to improve with his
neutrophils in induced sputum and are ster- asthma48.
oid-resistant. At this moment of medical sci-
ence development, this group will not bene- Responses to biological drugs in severe
fit from any of today’s known biologicals45. asthma are defined as super responders, par-
Once again, the most important factor is tially responders and non-responders50. In this
to distinguish and properly define the asth- group of 114 Dutch patients with severe asth-
ma phenotype, to identify all comorbidities, ma treated with antiIL-5 therapy, it was es-
the level of symptoms with the quality of life tablished that 14% of super responders, after
achieved with standard asthma treatment two years of follow-up had no residual man-
and good adherence, and to assess the poten- ifestation of asthma. The majority consisted
tial benefit of biologic therapy. This should be of partial responders, 69%, who have some
done in a precise medical manner, personal- asthma symptoms occasionally, while the
ly in just that patient, with defined goals in smallest group were non-responders, 11% of
asthma treatment by the patient himself48, patients whose asthma showed clinical wors-
while chronological age is the least important ening. Amongthe experienced residual man-
factor. ifestations of the disease most often were un-
controlled asthma symptoms, impaired lung
Of course, our goal is also to find young- function, and uncontrolled sinonasal symp-
er patients, able to work, or to improve their toms.
education, to ensure them a full life, by pre-
venting exacerbations and airway remodel- A reasonable period for assessment of bi-
ling with the least damage and side effects of ological treatment response in severe asthma
medical treatment of their asthma. patients is one (the first) year of treatment (12
months), enough to count the number of ex-
acerbations, oral steroid dosage, asthma con-
trol, eosinophilia, and estimate trends in lung
function.
(or Young) Should Our Patients Appropriate to Assess a Patient’s
be for Indication for Biologicals? Response to Biologicals (“Responder” controversies and dilemmas in severe asthma
or “Non-responders”)
Allergic asthma is usually an early-on-
set (during childhood, before the age of 12 We do not have a universally accepted defini-
years), but not necessarily, while eosinophil- tion of response to biologicals in severe asth-
ic asthma is usually a late-onset, but also not ma. There is no one parameter most impor-
necessarily. In children, after the age of 6 tant in an evaluation. Most experts agree that
years, omalizumab showed good tolerability it is necessary to assess different asthma el-
and safety, while anti-IL-5 treatment mepoli- ements during follow-up, from the clinical
zumab and benralizumab are recommended point (frequency of exacerbations, symptom
after the age of 12 years (reslizumab after the score), lung function, therapy dosages that
age of 18), as well as dupilumab with the in- patients need to control asthma symptoms,
dication for severe asthma46. Registries of se- as well as inflammatory biomarkers values49.
vere asthma patients show that the average In the present-day perspective, it is also essen-
age of severe asthma patients receiving bio- tial to have shared decision making. The im-
logicals is older than 50 years, with a median portance of a conversation should be empha-
of 56 years (with the oldest patient at the age sized, which will define the patient’s goals in
of 83 years)47. In the group of late-onset se- biological treatment–that together,the patient
vere asthma, there is also a group of patients and his physician should decide what the asth-
with a “Non-T2 high” phenotype. They have matic person would like to improve with his
neutrophils in induced sputum and are ster- asthma48.
oid-resistant. At this moment of medical sci-
ence development, this group will not bene- Responses to biological drugs in severe
fit from any of today’s known biologicals45. asthma are defined as super responders, par-
Once again, the most important factor is tially responders and non-responders50. In this
to distinguish and properly define the asth- group of 114 Dutch patients with severe asth-
ma phenotype, to identify all comorbidities, ma treated with antiIL-5 therapy, it was es-
the level of symptoms with the quality of life tablished that 14% of super responders, after
achieved with standard asthma treatment two years of follow-up had no residual man-
and good adherence, and to assess the poten- ifestation of asthma. The majority consisted
tial benefit of biologic therapy. This should be of partial responders, 69%, who have some
done in a precise medical manner, personal- asthma symptoms occasionally, while the
ly in just that patient, with defined goals in smallest group were non-responders, 11% of
asthma treatment by the patient himself48, patients whose asthma showed clinical wors-
while chronological age is the least important ening. Amongthe experienced residual man-
factor. ifestations of the disease most often were un-
controlled asthma symptoms, impaired lung
Of course, our goal is also to find young- function, and uncontrolled sinonasal symp-
er patients, able to work, or to improve their toms.
education, to ensure them a full life, by pre-
venting exacerbations and airway remodel- A reasonable period for assessment of bi-
ling with the least damage and side effects of ological treatment response in severe asthma
medical treatment of their asthma. patients is one (the first) year of treatment (12
months), enough to count the number of ex-
acerbations, oral steroid dosage, asthma con-
trol, eosinophilia, and estimate trends in lung
function.
