Resource explains treatment options for patients with severe asthma

The National Asthma Council Australia today released a new evidence-based resource for primary healthcare professionals to help explain the latest treatment options for patients with severe asthma.
 
The Monoclonal antibody therapy for severe asthma information paper has been developed using the latest available evidence.
 
Three monoclonal antibody therapies are currently available in Australia – omalizumab, mepolizumab and benralizumab.
 
All three are available for the treatment of patients with severe asthma whose disease is uncontrolled despite optimised standard care, including high-dose inhaled corticosteroids and long-acting beta2 agonists.
 
Monoclonal antibody therapies can reduce flare-ups, improve asthma symptoms and quality of life for people who experience severe asthma, and reduce the need for corticosteroids. Some may also improve lung function. They work by targeting inflammatory pathways that activate immune responses which lead to airway inflammation.
 
Monoclonal antibody therapies can be prescribed with Pharmaceutical Benefits Scheme (PBS) subsidy by certain specialists for patients attending an approved public or private hospital.
 
Before becoming eligible for PBS subsidy, however, patients must either have been treated by the same specialist for at least six months (a reduction from 12 months), or been diagnosed by a multidisciplinary severe asthma clinic team.
 
While these therapies may only be initiated by certain specialists, ongoing maintenance doses can be administered in primary care.
 
Patients taking monoclonal antibody therapies still require an up-to-date written asthma action plan. This needs to be reviewed yearly, or whenever the medication regime is changed.
 
‘It’s exciting to see the introduction of new treatment options for people with severe asthma,’ Professor Peter Wark, expert panel member and respiratory physician, said.
 
‘It is important to note that patients on monoclonal antibody therapy still require usual asthma care from their GP. They should be taking their preventer medicines regularly, and
their GP should continue to check adherence and inhaler technique from time to time.’
 
Before referring patients to specialists to consider starting monoclonal antibody therapy, the National Asthma Council Australia recommends checking and correcting common causes of uncontrolled asthma, such as incorrect inhaler technique and suboptimal adherence.
 
Next, the council recommends identifying patients with uncontrolled asthma who may benefit from monoclonal antibody therapy, and then offer referral for specialist assessment without delay.
 
Specialist referral is also advised for patients on long-term maintenance oral corticosteroids or for whom they are being considered, and for those who require frequent short courses of oral corticosteroids for acute asthma.
 
Patients taking monoclonal antibody therapy should be reminded to follow their written asthma action plan when symptoms worsen. They should also be reminded to attend all scheduled specialist appointments in order to remain eligible for accessing their monoclonal antibody therapy via the PBS.
 
When administering monoclonal antibody therapies, it is important that practitioners carefully follow instructions for storage, preparation and dosage administration. Patients should then be monitored under direct observation by a healthcare professional for at least 30 minutes after injections for maintenance doses.
 
Although monoclonal antibody therapies used in Australia are all generally well tolerated, the most common adverse events relate to injection site reactions.
 
Systemic reactions, including anaphylaxis, are rare but can also occur.
 
Severe asthma is asthma that remains uncontrolled despite maximal standard treatment (as per the Australian Asthma Handbook – step 4 or higher), or that can only be controlled with such treatment. It is not classified according to the intensity or frequency of symptoms.
 
According to a 2017 article in Australian Family Physician, 57.1% of patients with asthma saw their GP about their condition in the previous 12 months in 2011–12, while only 6% saw a specialist.

Asthma Monoclonal antibody therapy Severe asthma Uncontrolled asthma