The most important advances in asthma treatment

Paul M. O’Byrne, MB, is a professor of medicine and dean and vice-president of the Faculty of Health Sciences at McMaster University.

If you were to name the 3 most important recent advances in asthma treatment that are relevant for everyday practice, what would they be?

The 3 most important advances in asthma treatment in the past decade have been, firstly, the idea of using a reliever medication that contains both a rapid-onset bronchodilator, which is needed by asthma patients to improve their bronchoconstriction and their symptoms, but also an inhaled corticosteroid in the reliever medication. This approach has been shown to be extremely effective in reducing symptoms, of course, which is the reason the asthmatic patients use the reliever medication, but also is much better than using a short-acting beta-agonist (SABA) alone in reducing the risks of patients developing acute and severe asthma exacerbations.

The second advance, I think, that has been very important to asthma patients has been the introduction of a number of biologic therapies, which are, again, very effective in reducing severe exacerbation risk in patients but up to now these have been [used] mainly in patients with severe eosinophilic asthma not responding to the usual inhaled treatment approaches. There are currently 5 biologics available, which are approved for use in patients with either severe allergic or severe eosinophilic asthma and which, as I’ve already said, are used mainly to reduce exacerbation risk in patients.

The third important advance has been the introduction of a biologic that targets upstream of the currently available biologics by targeting an epithelial-derived cytokine called an epithelial alarmin. This cytokine is thymic stromal lymphopoietin (TSLP). This is the first biologic that has also been demonstrated to be effective in patients with noneosinophilic severe asthma and that has just recently been approved for use in a number of different countries.