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  • Reducing Limitations in Asthma Management
    As a complex and diverse condition diagnosed in over 26 million individuals in the US, asthma is an ongoing public health problem with significant societal and economic impact. Approximately 1.3 million visits to the emergency room a year are the result of asthma-related issues, and the total yearly economic costs are nearly $82 billion. Research to refine therapy approaches and develop novel personalized treatments is important for finding the best disease management options possible to help patients.

    Most mild or moderate asthma can be controlled with inhaled corticosteroids, which offer an anti-inflammatory effect in the airways to improve lung function. Medications such as fluticasone, mometasone, and beclomethasone are all common inhaled corticosteroids. Further controller therapy involves bronchodilators, which may consist of one or both of the two types depending on a patient's responses. Short-acting beta-2 agonists such as albuterol, terbutaline, or levalbuterol are helpful as rapid-acting medications used as rescue relief. If a patient needs to rely on them two or more times each week, a long-acting bronchodilator such as formoterol or salmeterol would be introduced as part of therapy along with inhaled corticosteroids.

    Asthma that proves to be difficult-to-treat and severe may benefit from treatment using biologics. Delivered by injection or infusion, these medications are able to target precise portions of the body's allergic response. For many years, omalizumab was the only available antibody for biological treatment of severe asthma. Since 2015, five more new biologic agents received FDA approval, including mepolizumab, reslizumab, benralizumab, dupilumab, and most recently, tezepelumab. The newest biologic, Tezspire (tezepelumab-ekko) injection, was approved as an add-on maintenance treatment to improve severe asthma symptoms when used with a patient's current asthma medicine. Tezspire works by targeting upstream inflammation mediated by thymic stromal lymphopoietin. This drug is an important new treatment since it is the first for severe asthma with no biomarker or phenotypic limitations.

    For the first time in over ten years, a revision to the asthma management guidelines from the National Heart, Lung, and Blood Institute was published. Six essential areas were addressed (intermittent inhaled corticosteroids, long-acting muscarinic antagonists, indoor allergen reduction, immunotherapy, fractional inhaled nitric oxide testing, and bronchial thermoplasty). The working group report noted that additional important areas still needed to be addressed, but due to a lack of sufficient data at the time, recommendations could not be developed. Asthma biologics were included in this list of emerging topics. The decision was made to release the guidelines without covering these areas in depth (omalizumab is addressed) rather than delay the release of the updates for additional years. With the explosion of research and advancement in this category, future updates will undoubtedly incorporate these newer therapies, giving practitioners further guidance on the widening array of therapies to help maintain optimum disease control for patients.

    For healthcare providers desirous of expanding their knowledge and skills in allergy/immunology, the upcoming American Academy of Allergy, Asthma & Immunology Annual Meeting will be held from February 25–28, 2022. Its theme is "Difficult to Control Asthma," which aligns with the current research and emerging therapies evolution. For many cases, personalized, targeted therapeutic approaches will be the most successful in controlling asthma over time.

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