It is the Cinderella of respiratory diseases. Often underestimated because it is considered easy to resolve and manage. We are talking about asthma which, however, in its severe form, is a complex and burdensome pathology, from both a physical and psychological point of view, with significant repercussions on work, school and socialization. Because often, despite diagnosis and treatment, the disease cannot be controlled and the symptoms re-emerge. According to experts, this is due to the limited use of the most innovative drugs, the biological ones, molecules designed to act selectively on the cells or mediators of inflammation directly responsible for asthma. To offer people with uncontrolled asthma the opportunity to carry out a free specialist assessment of the state of the disease and receive useful advice for its management, “Asma zero week” returns in May: two weeks of specialist consultations in around 40 pneumology centers and specialized allergologists throughout Italy.
“Severe asthma is a form of asthma that remains uncontrolled despite optimized inhaled treatment with high-dose corticosteroids and long-acting β2-agonists (ICS-LABAs). Severe asthma affects up to 10% of all asthmatics, including adults, adolescents and children, with around 300,000 cases in Italy”, explained Paola Rogliani, Full Professor of Respiratory Diseases, University of Rome Tor Vergata. Severe asthma remains an underestimated and poorly recognized pathology: “from a recent survey, which we proposed to our members, it emerged that many patients do not receive effective therapy and are not correctly included in a therapeutic path, thus having to take high doses of systemic corticosteroids (OCS) to control the symptoms of the disease”, underlined Simona Barbaglia President of the Association Respiriamo Insieme – APS.
The availability of new therapeutic options for asthma today offers the concrete possibility of operating a real paradigm shift compared to the past: as happened with other chronic diseases, even in asthma “remission” appears to be an achievable objective together with a simplification of treatment. “Remission is defined as a prolonged absence of symptoms and exacerbations, stabilization of lung function and no need for systemic corticosteroids to treat the disease”, specified Giorgio Walter Canonica, Professor of Respiratory Medicine, Humanitas University.
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Alarm bells
Some biological drugs for severe asthma are directed against a particular type of inflammation, that signaled by the presence of high levels of eosinophils, white blood cells that contribute to the immune response against allergens and infections. An alarm bell for a correct diagnosis of this type of severe asthma may be the presence of other pathologies supported by eosinophils, such as chronic rhinosinusitis with nasal polyposis. And even in this case the use of corticosteroids is not effective: “even today, unfortunately, the frequent use of oral corticosteroids, even at high doses, does not allow adequate long-term control of disabling symptoms to be achieved, unlike what demonstrated with biological therapy such as mepolizumab for example”, said Andrea Matucci, 1st Level Director of SOD Immunoallergology, Careggi University Hospital – Florence. An Italian study, moreover, has shown that the quantity of inflammatory eosinophils is linked to the severity of the disease and could represent the important biomarker of disease severity.
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New targets
Alongside drugs that restore the balance of eosinophils, a new monoclonal antibody has recently been approved that acts on another target: thymic stromal lymphopoietin (TSLP). It is called tezepelumab and it expands the therapeutic options available for the different phenotypes of asthma patients. “This allows us to extend the treatment possibilities for patients suffering from severe uncontrolled asthma, making them eligible for a specific biological therapy”, underlined Rogliani. Even in the case of asthma, therefore, each patient should be assessed for his specific characteristics and treated in a personalized way.
Countryside
Finding the most suitable treatment for patients who have already received a diagnosis of asthma but are unable to control the disease is the objective of “Asma Zero Week”, promoted by FederASMA and ALLERGIE – Italian Patients Federation ODV, in collaboration with Respiriamo Insieme – APS, with the patronage of the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC) and the Italian Society of Pneumology (SIP/IRS) and in partnership with AstraZeneca. For them from 13 to 17 May and from 27 to 31 May it will be possible to have free specialist consultations in around 40 specialized pneumology and allergology centers throughout Italy, which can be booked on the toll-free number 800 628989 active from Monday to Friday, from 9:00 to 1pm and from 2pm to 6pm.