Of all biological imperatives, perhaps the strongest is the need for air.
With lungs laboring to breathe, patients in the midst of an asthma attack may feel not only pain but also panic.
A century after immunotherapy became available to help modulate the allergic triggers of asthma, there continues to be an ongoing effort to modify, accelerate or develop more convenient forms of treatment.“Expanding treatment options has become a trend in asthma care. Several emerging treatments are now available or in study targeting the allergic cascade that exacerbates asthma,” John Anderson, MD of Alabama Allergy and Asthma Center said.
Gradually desensitizing patients to the effects of allergens by injecting small amounts of the protein that triggers their reaction has been a standard strategy for treatment. It hasn’t been without problems, however. In addition to the risk of triggering a reaction, the complexity of whole proteins can make standardizing doses a challenge.
“To reduce the risk of problems related to whole proteins, current research is focused on using peptides from a small portion,” Anderson said. “Studies of people with cat allergies have demonstrated the efficacy of this approach. Using peptide immunotherapy to induce tolerance could bring patients relief from a wide range of other allergens in the future.”
Injectable manmade anti-IgE antibody molecules are another recent addition to the arsenal of therapies to treat allergic asthma.
“Omalizumab has been on the market a few years now and has shown efficacy in blunting the effects of allergy triggers,” Anderson said. “Patients come in for injections once or twice a month. Cost can be a consideration, so for now we use this primarily in severe cases that don’t respond to other treatment. There’s a great deal of potential for using anti-IgE molecules to help more patients in the future.”
Other molecules being studied are aimed at reducing eosinophil production or reducing their longevity. Current human trials are also evaluating the effectiveness of blocking cytokines to reduce allergic response.
“Medical technology is another area where advances in asthma treatment are happening,” Anderson said. “For patients with severe asthma that isn’t controlled by medication, bronchial thermoplasty may be an option to consider. It uses radiofrequency energy to reduce smooth muscles in the lungs to help alleviate tightness.
“One helpful tool we use in our practice measures nitric oxide levels in lungs to help us determine the degree of eosinophil inflammation. This gives us a much better sense of how our patients are responding to medications. It helps us tailor therapy to the individual patient and reduce side effects by avoiding excess medications. It also helps us open communication with patients and improve adherence to medications when we can show them the effects of not taking meds versus taking them,” Anderson said. “The device is FDA approved and a helpful tool, but it isn’t covered yet by many health plans. The cost is reasonable, so patients who would benefit can usually afford it as an out of pocket expense.”
Anderson says two other trends in asthma research and care are developing easier methods for using medications and in tailoring treatment for greater patient autonomy.
“For some treatments that have traditionally been injectable, there is research aimed at developing sublingual tablets and drops. Work is also being done to replace twice-a-day inhalers with once-a -day inhalers. This should improve patient adherence and reduce persistent long term symptoms by eliminating the need to remember a second dose.
“There is also a lot of discussion about dosing strategies. In patients with mild persistent asthma, there is some thought that a demand dosing approach might be more workable. It’s an off label approach, but using inhalers as symptoms emerge would give patients more autonomy and could possibly lead to more usage before problems become worse, which could help prevent exacerbations.
“Research is also showing that asthma is a condition with very heterogeneous phenotypes. One approach to treatment doesn’t fit all. We need more specific therapies,” Anderson said. “In the years ahead, we should soon be able to look at a patient’s genetic code for clues to help us determine which medications are likely to work best in which cases.”
“That should help us reduce the risk of side effects from drugs that aren’t likely to work, and from higher doses of drugs that should work well at a lower dose. It should also help our patients get the relief they need a lot faster.”
