A Revolution for Asthma Treatment
Asthma treatment has undergone revolutionary improvements in the last 5 years. In the past, the standard therapy for patients who woke coughing in the middle of the night or with shortness of breath on walking was to have them take a combination of a 12 to 24 hours stimulant to beta receptors in the lung and steroid compounds. An example of such inhalers is Advair, Breo Ellipta, and Wixela. The new inhalers for asthma include a third component called Trilogy Ellipta (fluticasone furoate, umeclidinium, & vilanterol) which includes an anticholinergic or agent that dries up the mucous.
Despite these advances 10% of asthmatics do not have control of their asthma. They may have normal pulmonary function or breathing tests but they may have major symptoms. The white blood cell called the eosinophil, which is a major example of allergic cells, is targeted. These cells are called eosinophils because they stain red and represent inflammation that is not suppressed by the combination inhalers. New medications include Nucala and Fasenra which target eosinophils and are injectable. They average once per month or two months. Eosinophils are designed to kill parasites and have many chemicals that can damage normal tissue such as the lung cell or other tissue in the region. These medications target an interleukin called interleukin-5. Another medication that is given every two weeks is Dupixent which targets interleukin-4 and 13 combined. This medication also treats other allergic conditions, such as atopic dermatitis and nasal polyps. The basis of these different diseases may be the same biologic abnormalities. Nucala was just approved to treat nasal polyps.
Lastly, a new medication, Tezspire, is the first one to target an hormone on the surface of the lung tissue. It also targets, for the first time, the direct damage of the lung tissue with longstanding asthma. This medication works in addition to the underlying medications. There is another injectable, Xolair, which has targeted the immunoglobulin-E (IgE) or allergic antibody. Xolair was the first of the injectables released back in 2003. This injectable does improve symptoms and does not change lung capacity. I will elucidate on these new approaches to treating asthma in a forthcoming blog post.
If you need to book an appointment for your allergies or asthma, you can book your appointment online, or call 212-247-7447.