Imagine a future in which treatment goals we once thought unattainable could be reached. GSK, along with global specialists and patient organisations, is aiming to achieve just that by applying years of expertise in respiratory disease, and a deep understanding of the immune system, to develop solutions that can help some people with severe asthma achieve clinical remission.
Asthma affects more than 300 million people worldwide and varies in terms of severity.
People with severe asthma can face many years before they receive a specific diagnosis of their type of asthma, wasting time, sometimes year, of frustrating trial and error approaches to treatment options. Alongside the ongoing damage caused to a patient’s lungs due to avoidable exacerbations, this can also take a toll on their mental health, work and social life.
Achieving clinical remission could significantly improve the quality of life of severe asthma patients, minimising the risk of attacks – known as exacerbations – and allowing them to enjoy activities they never thought possible.
Only recently has the concept of clinical remission as a treatment goal been applied to asthma. Today scientists and physicians have a far greater understanding of the different biological causes of asthma and it is now known that not all asthma is the same, the causes and symptoms varying from person to person.
WATCH: Joelle and her mother Shelby (a GSK employee) share their experiences of the reality of life with severe asthma and why the evolution of its management is so important.
This knowledge along with the availability of more targeted treatment approaches means it is time to be more ambitious for patients and aspire to achieve clinical remission.
Geoffrey Chupp, MD, Professor of Medicine and director at Yale Center for Asthma and Airways Disease, says: “I think it’s really exciting that we’re talking about ‘how’ to achieve remission in patients with asthma as opposed to ‘if’ we can, and so I think we’re going to start to recognise that it could be possible to achieve remission in some patients.”
What is clinical remission in severe asthma?
Two key goals of clinical remission are for people with severe asthma to be free from exacerbations – also called asthma attacks – or the need for OCS.
The full definition of clinical remission in severe asthma is currently defined as the absence of exacerbations (asthma attack) for 12 months, the absence of significant symptoms, and no use of OCS for at least 12 months.
Experts also include the optimisation of lung function as a fourth parameter. However, this may be difficult to achieve if there has been a delay in medical intervention, or if irreversible lung damage has accumulated after each exacerbation.
For people with severe asthma, clinical remission can mean not having to experience frightening exacerbations, hospitalisations, and the side effects of OCS, which can include weight gain, anxiety and sleep disturbances. Long-term use is also associated with an increased risk of diabetes, cataracts and osteoporosis. Some patients have additionally reported that the emotional burden of severe asthma has reduced and that they can enjoy daily activities without debilitating symptoms.
However, while remission in asthma is a step closer, it is not a cure. Some patients can only achieve remission while on treatment and although free from exacerbations and the need for OCS, patients may still require rescue inhalers.
Due to the nature of the severe asthma, even once remission has been achieved, there’s a chance that a person’s condition could still deteriorate over time.
Preventing deterioration by reducing the risk of common infections with vaccines, or timely interventions with appropriate, evidence-based treatments, could stave off the disease progression of asthma and the early lung damage it can cause.
Shelby Gorman, a GSK employee, knows all too well the negative impact of severe asthma on a child’s life. Shelby’s daughter, Joelle, has recently turned 18. She was diagnosed with severe asthma aged 14.
“The doctor said to us, ‘When was the last time you had a day when you felt good all day?’,” Shelby says.
“My daughter couldn’t remember. She could not remember one day when she felt well ever, in her life. I think it’s so important for doctors to understand that, beyond the condition, how bad severe asthma can make people feel.”
After many years of trying multiple different medications, and frequently being hospitalised due to exacerbations, Shelby’s daughter received a more accurate diagnosis of her asthma, which identified the underlying biological cause of her asthma, and in turn led to her being started on an appropriate targeted treatment. For the first time she was able to live her life with renewed energy and vigour. Joelle hasn’t required her rescue inhaler for over a year, has not had any respiratory infections and no longer needs to take daily antihistiamines.
“I noticed the changes and said to my daughter, ‘Oh my gosh, you just got up the stairs, and you’re not out of breath,’” Shelby says.
“She would be like, ‘Oh yeah, oh my gosh!’ We would go for a little walk with the dog, and she would say, ‘No, I can do another lap, let’s do another lap, I can do it.’ And then we realised it had been months since she required any intervention of a nebuliser. Then we realised she was sleeping through the night.”
Who could achieve remission?
Some people with severe asthma are more likely to achieve clinical remission than others. Better outcomes are observed when appropriate treatments are started as soon as possible when the accumulative and irreversible lung damage from exacerbations can be minimised. Timely intervention may also reduce the exposure to OCS and any accumulation of the associated side effects. Treatments are also likely to be more effective in patients with a lower body mass index who are non-smokers.
Nevertheless, people with severe asthma who may not achieve remission can still benefit from accurate diagnosis of their asthma and management strategies to reduce exacerbations and doses of OCS as much as possible. Even one avoidable asthma attack is an attack too many.
“I do believe that there is a future within the next five years where we can start talking about really durable remissions in some patients with the disease and I think that’s going to be really amazing,” says Dr Chupp.
Is remission possible in other immune-mediated diseases?
Advances in science and medicine means that remission is already considered to be an accepted treatment goal in many other immune-mediated conditions, such as rheumatoid arthritis, and eosinophilic granulomatosis with polyangiitis (EGPA).
These conditions have a common link: a dysfunction in the immune system that gives rise to overactivity and excessive inflammation, causing it to attack the body as if it were a threat.
Identifying drugs that address the precise dysfunction in the immune system in immune-mediated diseases, without dampening the entire system, and with minimal side effects, is a challenge scientists continue to explore solutions to.