Claudio Micheletto1*, Alice Sparacino2 and Erika Zanardi1
1Respiratory Unit, Azienda Ospedaliera Universitaria Integrata Verona, University Hospital, Italy
2Respiratory Unit, IRCCS Centro Neurolesi "Bonino Pulejo", Italy
Asthma is a heterogeneous disease characterized by chronic airways inflammation. Most patients, using a Long Acting Bronchodilator Agent (LABA) associated with Inhaled Corticosteroids (ICS) in a single inhaler, achieve control of their symptoms. Nevertheless, cohorts of patients, defined as severe asthmatics, suffer daily symptoms and are at high risk of exacerbation and hospitalization, despite correctly adhering to an appropriate therapy regimen. Treatment for severe asthma is now focusing on tailoring to particular phenotypes driven by the endotypes. This review will focus on some exciting new therapeutic options that are already being recommended or are soon to be so, for the management of severe asthma. The first option is to add tiotropium, a long-acting muscarinic receptor antagonist, than can improve lung function and reduce exacerbations in patients not controlled by ICS/LABA. The second option, particularly for severe asthma with eosinophilic inflammation, is the biological treatment. Omalizumab, a monoclonal antibody to IgE, improves asthma control in patients with a predominant allergic phenotype. Monoclonal antibodies targeted to interleukin 4α (Dupilumab) and interleukin 5 (Mepolizumab, Reslizumab, Benralizumab) have shown substantial benefit in patients with the eosinophilic asthma phenotype. Bronchial thermoplasty, a new technique to reduce airway smooth muscle mass, improves symptoms and reduce exacerbations in patients with severe uncontrolled asthma and the chronic airflow obstruction phenotype. Only by better understanding the characteristics of asthma in uncontrolled patients will we be able to address the challenges of severe asthma with the new and innovative approaches reviewed and discussed here.
Micheletto C, Sparacino A, Zanardi E. New Options for Controlling Severe Asthma. Clin Respirat Med. 2019; 2(1): 1008.