The crushing effect of severe asthma


Edward Piper, MD

Compared to high profile causes of death including cancer and cardiovascular disease asthma hasn’t always received its fair share of focus in the past. This hasn’t been great news for the more than 300 million people worldwide who live with it—even less so for the 10 percent of asthma patients who endure a severe form of the disease.

Today, that’s changing. And, the why and how of that change is very good news, indeed.

First, though, it’s important to understand differences in the patient experience of asthma. Many people with this condition do just fine, they’re able to control their symptoms and live, for the most part, just like the rest of us. It’s those with a severe form of asthma that we worry about, and for whom life is often a daily struggle to control symptoms and to function normally.

As someone who spent a good part of his career as a practicing physician, I’ve seen first-hand the outcomes of an asthma attack, or what we call an asthma exacerbation, which, even now, can be fatal. More than anything, patients with severe asthma fear those exacerbations, which can occur unpredictably often with limited warning.

This gets us to the reason why there is now more attention on asthma. Clearly, one patient in terrible distress is one patient too many. The problem has been that asthma in the past has been treated—like many medical conditions—with a one-size-fits-all approach. That hasn’t accounted for what we now know about asthma, which is that it is heterogenous and comprised of several distinct patient subsets driven by different underlying disease biology. That we now understand this means we can begin to identify these subtypes and differentiators.

And, focus we have. Research has revealed strong data implicating two different key cytokines interleukin-5 (IL-5) via eosinophils and interleukin-13 (IL-13) via impact on multiple cell types that play a critical role in severe asthma.

This knowledge has made it possible for us to tackle the how of asthma therapy: to work toward developing targeted drugs—driven by personalized healthcare—and to identify which patients are most likely to respond to specific drugs targeting each of these cytokines.

We believe this right drug for the right patient approach is on the right track, and we have two targeted investigational biologics—benralizumab against IL-5/eosinophils and tralokinumab against IL-13—in clinical studies. So far, we’ve seen some encouraging data. This includes a simple blood test for our upcoming Phase III benralizumab trial that can identify patients with elevated blood eosinophils who might benefit from therapy whilst in Phase III for tralokinumab we are confirming the optimal blood marker to do the same job to target this drug to the right patient.

Patients with severe asthma don’t deserve to live in fear of exacerbations or symptoms. It’s clear that there’s a distinct need for targeted therapies, and our goal is to confirm the promise of our earlier clinical trial data for these two biologics. We think that’s good news.