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Asthma: innovative treatments ‘tailored to the individual’

Dr Desmond Murphy

Consultant Respiratory Physician at Cork University Hospital

Treatments for asthma have improved significantly over the last few years. People with poorly managed conditions have more options available.

Twenty years ago, the main treatment options for asthma patients were blue ‘reliever’ inhalers and brown ‘preventer’ inhalers. The blue ‘reliever’ inhaler contains the medication salbutamol or an adrenergic receptor agonist called terbutaline. Similarly, the brown ‘preventer’ inhaler contains which contain a low dose of corticosteroids.

While these devices are still used in frontline asthma control, they aren’t the only answer for sufferers of the condition. Various innovative treatments from multiple drug companies are currently available and have made a big difference to people with asthma. Dr Desmond Murphy, Consultant Respiratory Physician at Cork University Hospital.

Asthma is an inflammation of the lining of the airways, the tubes which carry air to the lungs. During an asthma attack, these tubes become narrow and make it airflow difficult, affecting an individual’s breathing. Symptoms can include breathlessness, wheezing, coughing and tightness of the chest. Depending on the severity of the attack, this can be frightening and occasionally even life-threatening. Yet asthma is a common condition affecting an estimated 10-15% of Ireland. Typically it presents in childhood and teenage years, says Murphy. But it can start at any age with some patients only displaying symptoms in their late 40s or 50s.

Understand your trigger

“People have their own asthma ‘triggers’,” explains Murphy. “This might be a chest infection, cold air, pollen, or all of the above. That’s why it’s such a complex condition — one which depends on environmental factors as well as an individual’s genetic make-up.” Understanding your personal trigger is an essential part of controlling your asthma.

When it comes to treatment, inhalers reduce inflammation, open up the airways and increase lung capacity. “Providing someone has normal lung function, initial treatment for asthma is a blue salbutamol ‘reliever’ inhaler,” says Murphy. “However, if an individual is increasingly having to take their blue inhaler, they might need to use it in conjunction with the brown steroid ‘preventer’ inhaler. After that, if they are still having to use their blue inhaler three or four times a week, their healthcare professional might need to escalate therapy with a combination inhaler”. This includes a long-acting reliever to relieve symptoms, and a corticosteroid preventer to help prevent airway inflammation.

Exercise-induced bronchoconstriction

Anyone taking exercise should ensure they have their inhalers with them at all times as some attacks can be exercise-induced. “90% of people with asthma will experience exercise-induced symptoms,” says Murphy. “Although narrowing of the airways can happen during exercise in a small number of people without asthma.

“However, many athletes have asthma. Paula Radcliffe, David Beckham, Paul Scholes, Ronan O’Gara and John O’Shea, for example — and it hasn’t impaired their performance. Parents of children with asthma should know, often the condition shouldn’t be an impediment to achievement in sport.”

Hi-tech novel treatments

The inhaler therapy controls the majority of asthma cases, says Murphy. But if these treatments have been tried and an individual’s asthma is still difficult to control, then this could indicate a severe, persistent case which might require more hi-tech, novel treatments.
This might include an injection every 2-4 weeks with a humanised antibody called omalizumab, which blocks immunoglobulin E, a substance in the body that is one of the main causes of inflammation in allergic asthma.

The next 12-24 months will bring newer asthma drugs says Murphy. “These include an anti-IL5 compound which would target hard-to-control asthma.”

Bronchial thermoplasty is another relatively new treatment for those with severe asthma — one which has made headlines in the last few years. “Thermoplasty is a procedure which heats the airwaves to between 60 and 70 degrees Celsius, killing off the abnormal muscle cells,” says Murphy. “The evidence for this is still emerging but initial trials were positive.

Regular asthma review

It’s an exciting time for anyone involved in asthma healthcare says Murphy. He says, “there are a plethora of inhalers available,”. “There are MDIs (metered-dose inhalers) and different types of powder inhalers (which give the medicine in a dry powder instead of a spray). There is also an inhaler called tiotropium, which was traditionally used for patients with emphysema but is now shown to be useful in patients with asthma, too. And, apart from new medications coming to market, thermoplasty could have an increasing role over the coming years.

All of this means that healthcare professionals can now tailor specific treatments to their patients and have more options when treating more difficult cases, rather than simply putting them on steroids which have multiple potential side-effects.”

To ensure your asthma is well-controlled, Murphy recommends that you have a regular asthma review with your healthcare professional. “Patients should have a review every year. This can assess inhaler technique and check if they need to increase / decrease their inhaled corticosteroid,” he says. “If their condition is not well-controlled they should obviously be seen by their GP as soon as possible.”

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