Approximately three million Canadians live with asthma, a chronic inflammatory disease that affects airways, limits airflow and makes breathing difficult, said Dr. Erika Penz, associate professor in respirology, critical care and sleep medicine at the University of Saskatchewan, during a webinar hosted by Benefits Canada and sponsored by GSK in November.
Asthma, which affects people of all ages, is mild for some and very severe for others, she added, noting between three per cent and eight per cent of those living with asthma have severe asthma, where they have more difficulty achieving control of their disease, despite proper use of medications.
Asthma is heterogeneous and, for treatment, one size doesn’t fit all, which is why it’s important to understand each patient to determine the best protocol, said Penz.
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Management of asthma begins with non-pharmacologic approaches and often progresses to corticosteroid treatment, which, according to Penz “can lead to lead to lots of health problems and comorbidities,” such as higher rates of anxiety and depression and weight gain, in addition to an increased risk of infections or sepsis, ulcers, bone health loss, pneumonia or cardiovascular disease. Which is why, she said, “we really want to avoid the use of corticosteroids.”
Phenotyping to classify an individual’s asthma are “biomarkers that help us to choose the right treatment for the right patient,” she noted.
Certain white blood cells called eosinophils are found in a large majority of patients with severe asthma and indicate if patients could be good responders to some biologic treatments for asthma. “Eosinophil counts inform our practice and allow personalized patient management.”
Identifying these patients and intervening early could prevent complications and improve their quality of life, said Penz, noting patients who aren’t treated appropriately will have ongoing inflammation in their small airways, which could lead to remodeling of the airways where they become thicker and narrower over time, making it harder to breathe.
“We now have several biologic therapies available in Canada for severe asthma patients” she said, adding they work when used for the right patient, have good safety profiles, very low risk of side-effects and reduce the risk of future exacerbations of asthma. “Biologics can have a life-changing impact in terms of improving disease control and quality of life for patients.”
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Penz also shared evidence that biologics for asthma reduce exacerbations by 60 to 80 per cent and decrease hospitalization and patients’ reliance on oral corticosteroids. “It’s remarkable the impact that this these drugs are having on this population in terms of their ability to return to work and be productive.”
After the use of a biologic treatment for asthma, workplace absenteeism dropped between 20 per cent and two per cent after six months, according to studies, she noted.
In addition, Penz said asthma treatment has improved by using a biomarker-based approach, which “tailors our understanding of someone’s asthma so that we can offer them treatment that is more specific and gives them a better chance at excellent outcomes.”