22 March 2017
By Dr Samantha Walker, Director of Research and Policy, and Deputy Chief Executive at Asthma UK.
It’s easy to take for granted the simplicity and ease of breathing but for people with severe asthma the struggle for breath is something they contend with all too often. This overshadows much of their daily lives and often affects their ability to carry out the simplest of tasks.
For the vast majority of people with asthma, inhalers can help maintain control of symptoms if used correctly. But for people with severe asthma, they face a different and unpredictable day-to-day reality. Rather than being simply an extreme form of the condition, severe asthma is a specific type of asthma that does not respond to current readily available treatments.
In our new report, Severe asthma, we highlight the unmet treatment need for those with the condition, and the key research challenges that need to be tackled in order to ensure that new effective treatments are developed.
The need for alternatives to oral steroids
The standard treatment option for people living with severe asthma is the corticosteroid tablet. Whilst these cheap treatments are usually effective they are extremely toxic when taken over the long term, with side effects including mood swings, weight gain, osteoporosis and diabetes.
With the alternative being a potentially life-threatening asthma attack, there is little choice for people with severe asthma but to accept and deal with the side effects of oral corticosteroids. This Hobson’s Choice for severe asthma treatment is completely unacceptable, and we must give people a real alternative that treats their condition without creating another problem to solve.
Until recently, our limited understanding of the mechanisms driving asthma meant that the prospect of new therapies seemed bleak. However, we are on the cusp of new discoveries which could bring us a step closer to a cure if we are strategic in our thinking and our efforts.
Towards precision medicine
Asthma has for a long time been regarded as the same condition independent of severity and pattern of symptoms, but it is becoming increasingly clear from research that it is not one condition but many, and that there are several sub-types of severe asthma. Internationally-respected scientists such as Professor Sir John Bell have gone so far as to say that asthma now presents the best example for precision medicine, where treatments are tailored to a specific sub-type.
In practice we have only begun to scratch the surface of the potential for precision medicine in asthma. With further investment in biomarkers and new diagnostics to better identify sub-types, and new treatments targeted to them, we could see severe asthma leading a new era of personalised medicine in the NHS.
There is a healthy pipeline of innovative new treatments that have been shown to be effective in severe eosinophilic asthma – such as mepolizumab (recently approved by NICE), and reslizumab (currently being considered by NICE and the SMC). However, for people with severe non-eosinophilic asthma (around 60% of the overall severe asthma population) the pipeline is under-developed and in urgent need of investment.
Driving investment in research
We cannot meet this research challenge in isolation. This requires pooling our efforts, reducing risk of failure through collaborations and driving global investment by pharmaceutical companies as well as public investment in research.
It will require large trials in people with different types of asthma, recognising that the pool of people to recruit from gets smaller and smaller within individual communities and countries as further sub-types are identified.
And it will require international multi-sector, multi-disciplinary collaboration and significant financial investment as trials are increasingly expensive, a challenge that the international asthma community needs to rise to.
We are well placed in the UK to spearhead much of this work, and we have led the way in identifying the most important research priorities in asthma R&D to guide focus and investment, which are now being adopted internationally. Our vision is that this focus on a small number of key areas, namely understanding what causes and triggers different types of severe asthma, and creating new ways of identifying them, will lead to a new generation of treatments for severe asthma – transforming the lives of people with severe asthma in the years to come.