New guidelines to treat severe asthma recommend ‘evaluating first, treating second’

Recent guidelines for severe asthma expand treatment options, but there remains a subset of patients that don’t fit the latest treatment paradigms. One new recommendation from the European Respiratory Society (ERS), the American Thoracic Society (ATS), and the Global Initiative for Asthma (GINA) fits all patients: Evaluate first, treat second.

A panel of experts will discuss the practical application of new guidelines during Treatment of Severe Asthma: Updates From the Guidelines, Part 1 on Tuesday, October 20, from 7:30 am to 8:30 am CT. The session will be available for on-demand viewing 24 hours later on the virtual CHEST 2020 meeting platform through January 18.

Clinicians can pay closer attention to patients who seem to fit the guidelines for specific agents and then fail to respond as expected. Looking beyond the conventional biomarkers can pay dividends in new treatments or new approaches with existing treatments.

“We have learned a lot about severe asthma phenotypes in the last 10 years, including the use of new biologic agents for the treatment of patients with Th2 diseases,” said Sunita Sharma, MD, associate professor of pulmonary sciences and critical care at the University of Colorado School of Medicine and chair of the session. “We are moving closer to personalizing treatment for many of our patients with severe disease.”

“Part of what we are doing with this session is looking beyond the guidelines to see where we can use additional research and development to move the needle with subsets of our severe asthma patients who aren’t responding to standard therapies recommended by the guidelines. There may be additional data to be gleaned from these patients that may help us identify new therapeutic targets or other disease modifiers that we might be able to use to treat our severe patients more effectively.”

Better phenotyping of patients can also help identify treatments that are more likely to work. All of the new biologic agents that have been approved for allergic asthma over the last few years target different allergic pathways, noted Anne Reihman, MD, pulmonary sciences and critical care fellow at the University of Colorado School of Medicine. Each is more likely to be effective in different subsets of patients.

“We didn’t have a lot of data on these new biologics until recently, so they were not included in earlier asthma guidelines,” Dr. Reihman noted. “Our latest guidelines do include them, which opens up new avenues of care for more patients. The biggest change to clinical practice is recognizing the need to better understand your patients and figure out which agent is likely to be most appropriate for each patient before you start treatment.”