Treatment options for Severe Asthma

Until recently, the main pharmacotherapy for these patients was repeated courses of oral corticosteroids. Long-term use of oral corticosteroids has been associated with serious side effects, including type 2 diabetes, osteoporosis, gastric disorders, obesity, hypertension, cataracts, and obstructive sleep apnoea. More recently, asthma is being characterised by the specific underlying biological mechanism, which can then be used to identify biomarkers and develop therapies targeting the underlying mechanisms.

In recent years there have been an explosion of novel therapies for the management of severe asthma which can be offered in secondary care:

Anti-IGE therapy (Omalizumab) is an injectable therapy used to treat a subgroup of patients with severe allergic asthma. Follow this link to read more about the strict criteria for eligible patients.

Mepolizumab is another monoclonal antibody aimed at interleukin 5, which is also involved in asthma inflammatory cascade. It’s also used in the treatment of severe eosinophilic asthma. This treatment is given as a subcutaneous injection every month. Follow this link to read about the strict inclusion criteria for these patients.

Occasionally we use treatments such as long term prophylactic antibiotics and antifungal treatments for patients with fungal associated asthma

Bronchial thermoplastic involves the delivery of therapeutic radio-frequency energy to the airway tissue and reducing the amount of smooth muscle and reducing airway hyper-responsiveness. This procedure is used for some patients at more severe end of the spectrum.

All of these treatments are accessible only in secondary care, and the eligibility criteria is very strict. It’s important that the patients are systematically evaluated and to assess which patients are likely to benefit from these additional therapies.

Those patients who have uncontrolled asthma despite good doses of standard asthma therapy should be referred to secondary care because there is treatment that can be offered to those patients.

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