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Severe T2-high asthma in the biologics era: European experts' opinion

Ian Pavord, Thomas Bahmer, Fulvio Braido, Borja G. Cosío, Marc Humbert, Marco Idzko, Lukasz Adamek
European Respiratory Review 2019 28: 190054; DOI: 10.1183/16000617.0054-2019
Ian Pavord
1Nuffield Dept of Medicine and Oxford Respiratory NIHR BRC, University of Oxford, Oxford, UK
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Thomas Bahmer
2Dept of Internal Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
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Fulvio Braido
3Dept of Internal Medicine, Respiratory Diseases and Allergy, University of Genoa, Ospedale Policlinico IRCCS San Martino, Genoa, Italy
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Borja G. Cosío
4Hospital Universitario Son Espases, Palma, Spain
5Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Marc Humbert
6Faculté de Médecine, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
7Service de Pneumologie, Centre de Référence de l'Hypertension Artérielle Pulmonaire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
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Marco Idzko
8Dept of Pulmonary Medicine, University Hospital Freiburg, Freiburg, Germany
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Lukasz Adamek
9AstraZeneca, Luton, UK
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  • For correspondence: lukasz.adamek@astrazeneca.com
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Tables

  • TABLE 1

    Important concerns in the management of severe asthma identified at the European Respiratory Biologics Forum

    How can biomarkers and phenotypes be best identified and utilised in daily clinical practice?
    Is the ACQ the right tool for monitoring the response to biologics?
    Is treatment response assessed using the ACQ related to the effect of treatment on exacerbations?
    How can awareness be raised among patients and non-specialists regarding the burden of oral corticosteroids and the potential of new treatments available?
    Are oral steroids effective in patients having exacerbations while on biological therapies?
    When should patients start and stop taking a biologic?
    When should patients be switched from one biologic to another?

    ACQ: Asthma Control Questionnaire.

    • TABLE 2

      Current status of biologics in severe asthma management

      Further understanding is needed on how and when to switch from one biological therapy to another
      There is still no consensus on the appropriate length of waiting time before a patient is classified as a non-responder
      The efficacy of biologics in severe asthma has been demonstrated in a number of trials in recent years, but further research is needed to understand the long-term effects of biological therapy
      Several clinical studies have demonstrated the oral corticosteroid-sparing effect of biologics
    • TABLE 3

      Core principles from the charter to improve patient care in severe asthma

      1I deserve a timely, straightforward referral when my uncontrolled asthma cannot be managed in primary care
      2I deserve a timely, formal diagnosis of my severe asthma by an expert team
      3I deserve support to understand my type of severe asthma
      4I deserve care that reduces the impact of severe asthma on my daily life and improves my overall quality of care
      5I deserve not to be reliant on oral corticosteroids
      6I deserve to access consistent quality care, regardless of where I live or where I choose to access it
    • TABLE 4

      Key challenges in incorporating the use of treatable traits in the management of severe asthma

      Education of non-specialists and patients
      Better identification of patients with severe asthma
      Regional standardisation of the referral pathway
      Real-life identification and application of phenotypes and biomarkers in clinical practice
      Further evidence on treatable traits
      Understanding the clinical relevance of biomarkers and phenotypes
      Understanding the value of combining different biomarkers and establishing criteria for their combination
    • TABLE 5

      The future of asthma management: scientific questions that need to be addressed

      How are acute and chronic oral corticosteroids managed once biologics are initiated in a real-life setting?
      How should a second-line biological treatment be chosen if a patient fails with first-line respiratory biological therapy?
      What are the different sub-phenotypes of non-eosinophilic asthma?
      Can the natural course of the disease be modified by early intervention with anti-interleukin-5?
      What is the effect of biological therapies on airway remodelling?
      Could there be a beneficial impact of biologics on the cost of treatment through home care delivery in the severe asthma population?
      What real-life factors could be used to distinguish between high and low responders to biologics?
      What is the effect of using biologics in an acute asthma setting?
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    Severe T2-high asthma in the biologics era: European experts' opinion
    Ian Pavord, Thomas Bahmer, Fulvio Braido, Borja G. Cosío, Marc Humbert, Marco Idzko, Lukasz Adamek
    European Respiratory Review Jun 2019, 28 (152) 190054; DOI: 10.1183/16000617.0054-2019

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    Severe T2-high asthma in the biologics era: European experts' opinion
    Ian Pavord, Thomas Bahmer, Fulvio Braido, Borja G. Cosío, Marc Humbert, Marco Idzko, Lukasz Adamek
    European Respiratory Review Jun 2019, 28 (152) 190054; DOI: 10.1183/16000617.0054-2019
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    • Article
      • Abstract
      • Abstract
      • The era of biologics for airways disease: where are we now?
      • Management of severe asthma with currently available biological therapies
      • Is it possible to recognise severe asthma earlier?
      • Monitoring treatment response and addressing the lack of adherence to medication
      • Initiating biological therapies
      • Acknowledgements
      • Footnotes
      • References
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    • Asthma and allergy
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