Being a physician is one of those professions when answering the question “What do you do?” still inspires an intake of breath and a degree of interest. When people question my specialty being “just asthma”, you might be surprised to learn that I’m not disappointed by this response. Mainly, because it is a comment my patients hear and are frustrated by regularly and, more importantly, because it allows me to educate people about severe asthma, a debilitating, life-threatening disease that affects up to an estimated 33 million people worldwide. 1-3
Having treated people with severe asthma for most of my career, I am all-too-familiar with the overwhelming impact of this disease. A survey of patients in the EU found that nearly 70% had to restrict their physical activity due to severe asthma.4 It is not hard for me to understand this insight, having seen how frequently my patients struggle to simply breathe. My patients have shared numerous anecdotes with me including how depressed they feel about not being able to do the normal things that their friends and family can do. Everyday life for many people with uncontrolled severe asthma is not easy.
The key word in that insight is ‘uncontrolled’. Asthma is a complex disease and while we have made strides in advancing our understanding of this disease, including its causes and management options, up to 38% of those with severe asthma do not have their symptoms adequately controlled. 5,6 These patients face frequent exacerbations and significant limitations on lung function and quality of life. 2,7 When severe asthma remains uncontrolled despite standard asthma medications, people may need to be treated with oral corticosteroids (OCS). 8 Whilst OCS can be effective in controlling acute asthma exacerbations and improving day to day symptoms, they have significant side effects.7,9 Chronic OCS use is associated with many serious health risks for people with severe asthma, including osteoporosis, cardiovascular disease, cataracts, anxiety/depression, diabetes and weight gain.10,11
As our understanding of severe asthma evolves, so must the systems responsible for delivering care to ensure that patients can benefit. It’s in this context that AstraZeneca has committed to redefining the management of severe asthma by improving the patient journey for people living with severe asthma and creating an environment where patients routinely receive the right care at the right time, in the most appropriate setting.
Through our research, we are working with global and national respiratory experts from clinical practice, patient advocacy groups and the payor and policy environment, to establish a clear pathway for accelerated patient referrals, build clinical capabilities, expand system capacity and evolve healthcare policies.
It is essential that the severe asthma community comes together to systematically improve the care that people with severe asthma receive, including adopting OCS-sparing strategies where possible. We are committed to transforming the way severe asthma services are designed and delivered to reduce the burden it places on the individual, the health system and broader society. I look forward to the day when even my most severely-affected patients will be able to agree that it is indeed “just asthma”.
Read the full feature story in The Economist to learn more about the physical and socio-economic burden of severe asthma and what can be done to improve severe asthma patient care.
1. The Global Asthma Network. The Global Asthma Report 2018. Accessed 6 September 2018. Available at: http://www.globalasthmanetwork.org/Global%20Asthma%20Report%202018.pdf. Accessed: August 2018.
2. Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014; 43: 343–73.
3. Wenzel S, Severe Asthma in Adults. Am J Respir Crit Care Med. 2005; 172 VOL 172; 149–160.
4. European Federation of Allergy and Airways Diseases Patients Association (EFA). A European patient perspective on severe asthma: Fighting for breath 2012. http://www.efanet.org/images/2012/07/Fighting_For_Breath1.pdf. Accessed September 2018.
5. Chen S, Golam S, Myers J , Bly C et al. Systematic literature review of the clinical, humanistic, and economic burden associated with asthma uncontrolled by GINA Steps 4 or 5 treatment. Curr Med Res Opin. 2018 Aug 16:1-14.
6. Adelphi Real World Respiratory Disease Specific Programme. 2012-2014. [Asthma patient data file], Bollington, UK. Unpublished raw data cited with permission.
7. Peters SP, Ferguson G, Deniz Y, et al. Uncontrolled asthma: a review of the prevalence, disease burden and options for treatment. Respir Med 2006: 100(7):1139-51.
8. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2018. Available from: https://ginasthma.org/2018-gina-report-global-strategy-for-asthma-management-and-prevention/.
9. Sullivan P, Ghushchyan V, Globe G, Schatz M. Oral corticosteroid exposure and adverse effects in asthmatic patients. J Allergy Clin Immunol. 2018;141:110-6.
10. Voorham, J. , Xu, X. , Price, D. , Golam, S. et al. Health care resource utilization and costs associated with incremental systemic corticosteroid exposure in asthma. Allergy. 2018 Jul 10. Epublished ahead of print.
11. Sweeney J, Patterson CC, Menzies-Gow A, et al. Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry. Thorax. 2016;71:339-346.
Veeva ID: Z4-12650
Date of next review: September 2020