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Optimal Asthma Control
Goes Beyond Exacerbation Reduction

 

Patients with uncontrolled persistent asthma may experience
higher exacerbation rates, impaired lung function, risk of long-term
OCS side effects, and poor quality of life1-6

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High exacerbation rates
High exacerbation rates
  • Exacerbations were 3 times more likely to occur
    in patients with uncontrolled asthma rates than in those
    with better asthma control1
 
Impaired lung function
Impaired lung function
  • Reversible airway obstruction in uncontrolled asthma is caused by bronchoconstriction and mucus production7-10
  • Airway remodeling, often driven by persistent Type 2 inflammation, can lead to impaired lung function in both the large and small airways7-10
 
Potential side effects of OCS
Potential side effects of OCS
  • Due to the potential for substantial side effects
    with OCS use, guidelines suggest not using OCS as
    maintenance therapy until all other pharmacologic
    options have been exhausted11,12
  • Long-term use of OCS has been associated with
    osteoporosis, arterial hypertension, diabetes and
    metabolic syndrome, dyslipidemia, obesity,
    cataracts, glaucoma, gastrointestinal bleeds/ulcers,
    tuberculosis, depression, herpes, and sepsis6,13
 
Poor QoL
Poor QoL
  • Patients miss out on outdoor, physical, and other
    daily activities4
  • Anxiety and depression worsen symptoms
    and complicate disease management5
 

Impaired lung function contributes to risk of future severe
exacerbations and poor asthma control1,14

Lung function is critical to the assessment of future risk in patients with asthma12

  • Patients with frequent exacerbations and moderate-to-severe asthma experienced
    a significantly greater annual decline in FEV1 in a long-term study, compared with patients
    who had infrequent exacerbations15
  • Early and sustained improvements in lung function following therapy initiation reduced
    the rate and severity of future exacerbations16

Lung function should be measured as part of the assessment of asthma control12:

  • At the start of treatment
  • After 3 to 6 months of treatment
  • Periodically thereafter for ongoing risk assessment
There remains an unmet need to provide
comprehensive care for patients with
uncontrolled persistent asthma1,12,17,18

FEV1, forced expiratory volume in 1 second; OCS, oral corticosteroids; QoL, quality of life.

References:
  1. Haselkorn T, Fish JE, Zeiger RS, et al; TENOR Study Group. Consistently very poorly controlled asthma, as defined by the impairment domain of the Expert Panel Report 3 guidelines, increases risk for future severe asthma exacerbations in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. J Allergy Clin Immunol. 2009;124(5):895-902.
  2. O'Byrne PM, Pedersen S, Lamm CJ, Tan WC, Busse WW; START Investigators Group. Severe exacerbations and decline in lung function in asthma. Am J Respir Crit Care Med. 2009;179(1):19-24.
  3. Nguyen VQ, Ulrik CS. Measures to reduce maintenance therapy with oral corticosteroid in adults with severe asthma. Allergy Asthma Proc. 2016;37(6):125-139.
  4. Haselkorn T, Chen H, Miller DP, et al. Asthma control and activity limitations: insights from the Real-world Evaluation of Asthma Control and Treatment (REACT) Study. Ann Allergy Asthma Immunol. 2010;104(6):471-477.
  5. Di Marco F, Verga M, Santus P, et al. Close correlation between anxiety, depression, and asthma control. Respir Med. 2010;104(1):22-28.
  6. Sullivan PW, Ghushchyan VH, Globe G, Schatz M. Oral corticosteroid exposure and adverse effects in asthmatic patients. J Allergy Clin Immunol. 2018;141(1):110-116.
  7. Elliot JG, Jones RL, Abramson MJ, et al. Distribution of airway smooth muscle remodelling in asthma: relation to airway inflammation. Respirology. 2015;20(1):66-72.
  8. Mauad T, Bel EH, Sterk PJ. Asthma therapy and airway remodeling. J Allergy Clin Immunol. 2007;120(5):997-1009.
  9. Fehrenbach H, Wagner C, Wegmann M. Airway remodeling in asthma: what really matters. Cell Tissue Res. 2017;367(3):551-569.
  10. Holgate ST. The airway epithelium is central to the pathogenesis of asthma. Allergol Int. 2008;57(1):1-10.
  11. National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma—Full Report 2007. Bethesda, MD: NHLBI Health Information Center; 2007. NIH publication 07-4051.
  12. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2018. http://ginasthma.org/2018-gina-report-global-strategy-for-asthma-management-and-prevention/. Accessed March 8, 2018.
  13. Rayos Prescribing Information. September 2017.
  14. Patel M, Pilcher J, Reddel HK, et al; SMART Study Group. Predictors of severe exacerbations, poor asthma control, and β-agonist overuse for patients with asthma. J Allergy Clin Immunol Pract. 2014;2(6):751-758.
  15. Bai TR, Vonk JM, Postma DS, Boezen HM. Severe exacerbations predict excess lung function decline in asthma. Eur Respir J. 2007;30(3):452-456.
  16. O'Byrne PM, Pedersen S, Lamm CJ, Tan WC, Busse WW; START Investigators Group. Severe exacerbations and decline in lung function in asthma. Am J Respir Crit Care Med. 2009;179(1):19-24.
  17. Agache I, Akdis C, Jutel M, Virchow JC. Untangling asthma phenotypes and endotypes. Allergy. 2012;67(7):835-846.
  18. Bjermer L. Time for a paradigm shift in asthma treatment: from relieving bronchospasm to controlling systemic inflammation. J Allergy Clin lmmunol. 2007;120(6):1269-1275.
  19. Wenzel SE. Emergence of biomolecular pathways to define novel asthma phenotypes: type-2 immunity and beyond. Am J Respir Cell Mol Biol. 2016;55(1):1-4.
  20. Robinson D, Humbert M, Buhl R, et al. Revisiting type 2-high and type 2-low airway inflammation in asthma: current knowledge and therapeutic implications. Clin Exp Allergy. 2017;47(2):161-175.
  21. Ray A, Raundhal M, Oriss TB, Ray P, Wenzel SE. Current concepts of severe asthma. J Clin Invest. 2016;126(7):2394-2403.