ASTHMA

RESPIRATORY

Asthma Control Tests (ACT) overview

<p>Dr. Ahmed Abbas, Consultant Pneumologist, Abu Dhabi, UAE and Assistant Professor of Respiratory&nbsp;Medicine, Egypt, provides an overview on ACT scoring.</p>

When do you discuss Biologic treatment with your Asthma patients?

<p>A Biologic option in severe Asthma</p>

Severe Asthma Biomarker's

<p>Eosinophils, lgE and FeNO - these clinical measurements can help us predict exacerbation risk and make informed biological selections<sup>1</sup>.</p>

Reference

The Vital Role of Lung Function in Asthma Care

<p>Forced expiratory volume (FEV1) is a very important physiological measure that predicts increased risk of exacerbations in certain respiratory conditions. FEV1 is a key indicator of lung function and airflow limitations, and monitoring changes in FEV1 can help healthcare providers assess disease progression and guide treatment decisions.&nbsp;<sup>1,2,3</sup></p>

References

Why is it important to look for Type 2 inflammation in patients with Asthma?

Sever Asthmatic patients with OCS

<p>Oral corticosteroids, the double-edged sword of severe Asthma. Even one or two courses of oral corticosteroids over the year increase risk of patients' systemic adverse events. Unfortunately, 93% of Patients With Severe Asthma have at least One Condition Related to OCS Use<sup>1</sup>*</p>

How do you choose the right Biologic for a particular Asthma patients?

<p>Choosing the right Biologic for Severe Asthma patients.</p>

What challenges do you face when treating patients with Type 2 inflammation?

<p>Treatment challenges&nbsp;in Severe Asthma.</p>

How do you balance the cost of Biologics with the value they can bring to patients?

How Type 2 inflammation affect patients with Asthma?

How does Dupixent improve Asthma control and quality of live for Pediatric Patients?

<p>&nbsp;KOL Expert on Asthma Control and Quality of Life for Pediatric.</p>

Fractional exhaled nitric oxide (Feno)

<h3>FENO: Simple non invasive direct measure of local airway inflammation in asthma which is a Predictor of:</h3>
<ul>
 <li>Loss of asthma control</li>
 <li>Risk of exacerbation</li>
 <li>Lung function decline</li>
</ul>

Asthma Clinical Remission: The Benchmarks for Eliminating Airway Inflammation and Symptoms

<p>What is the the Clinical Remission:&nbsp;<b>Clinical remission: ≥12 months of all of the following, whether on or off treatment</b>.</p>
<ul>
 <li>Consistent absence of significant asthma symptoms based on validated instruments</li>
 <li>Optimized and stabilized lung function.</li>
 <li>Patients and provider agreement of disease remission.</li>
 <li>No exacerbations required OCS and/or hospitalization</li>
</ul>

Consider Dupixent for Asthmatic patients with OCS use

<p>Dupixent proved its efficacy to lower the OCS use &amp; reduce exacerbations along with improving Lung function.</p>

Airway Hyperresponsiveness
in Asthma

<h2 style="text-align: center;">Proposed Framework for Remission<sup>1-7</sup></h2>

<table border="1" cellpadding="1" cellspacing="1" style="width:500px;">
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    <h3 style="text-align: center;"><span style="color:#ffffff;">Remission: A state or period with low to no disease activity that can be spontaneous or as a result of therapy<sup>6</sup></span></h3></td>
  </tr>
 </tbody>
</table>

<h3 style="text-align: center;"><span style="color:#1590a5;">Several Countries Have Recommended Clinical Remission Definitions<sup>1-5</sup></span></h3>

<p data-font="legal"><sup>*</sup>A broad consensus definition is being developed with over 120 experts and is expected in the GEMA 5.4 update.</p>
<p data-font="legal"><sup>†</sup>The US workgroup determined that symptom and lung function criteria must be met on all occasions measured in the previous 12-month period with a minimum of two measurements during the year.</p>

<table border="1" cellpadding="1" cellspacing="1" style="width:500px;">
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    <h3 style="text-align: center;"><span style="color:#ffffff;">The definition of on-treatment remission in asthma has not yet been established and further consensus among experts, guidelines, and societies is warranted.<sup>6</sup></span></h3></td>
  </tr>
 </tbody>
</table>
<p><span style="color:#1590a5;"><strong>This tool showcases the evolving evidence around asthma remission as of February 2024 and is intended for educational purposes only.</strong></span></p>
<p data-font="legal">ACQ, Asthma Control Questionnaire; ACT, Asthma Control Test; AirQ, Asthma Impairment and Risk Questionnaire; FEV<sub>1</sub>, forced expiratory volume in 1 second; ICS, inhaled corticosteroids; OCS, oral corticosteroids.</p>

<h2 style="text-align: center;">EVOLUTION OF ON-TREATMENT REMISSION IN ASTHMA</h2>
<h3 style="text-align: center;">How Can Therapeutic Intervention Get Us to On-Treatment Clinical Remission?<sup>6-10</sup></h3>

<h3 style="text-align: center;">Over 70-Years of On-Treatment Clinical Remission in Asthma</h3>

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   <td style="background-color: rgb(21, 144, 165);">
    <h3 style="text-align: center;"><span style="color:#ffffff;">Remission may be achieved on or off treatment. Different definitions of remission have been proposed and implemented in various studies. Given this evolving framework for remission, further studies may provide a pathway to inform our understanding of disease modification in severe asthma.<sup>6</sup></span></h3></td>
  </tr>
 </tbody>
</table>
<p><span style="color:#1590a5;"><strong>This tool showcases the evolving evidence around asthma remission as of February 2024 and is intended for educational purposes only.</strong></span></p>
<p data-font="legal">ICS, inhaled corticosteroids; LABA, long-acting beta agonist; SABA, short-acting beta agonist; SCS, systemic corticosteroids.</p>

<h2 style="text-align: center;">REDUCING EXACERBATIONS IS A FUNDAMENTAL CRITERION OF ASTHMA REMISSION<sup>1-7</sup></h2>

<p data-font="legal"><sup>*</sup>Adapted from GINA and ERS/ATS.&nbsp;<sup>†</sup>Severe exacerbation was defined as worsening asthma requiring at least 3 days of treatment with systemic corticosteroids, or a hospitalization due to asthma. ATS, American Thoracic Society; BD, bronchodilator; ERS, European Respiratory Society; FEV<sub>1</sub>, forced expiratory volume in 1 second; GINA, Global Initiative for Asthma.</p>

<h2 style="text-align: center;">ZERO OCS USE IS REQUIRED FOR A STATE OF ASTHMA REMISSION<sup>1-7</sup></h2>

<p data-font="legal"><sup>*</sup>Adapted from GINA and ERS/ATS.&nbsp;<sup>†</sup><em>P</em>&lt;0.001.<sup>20</sup><br>
  AE, adverse event; ATS, American Thoracic Society; ERS, European Respiratory Society; GI, gastrointestinal; GINA, Global Initiative for Asthma; OCS, oral corticosteroids.</p>

<h2 style="text-align: center;">ACHIEVING LUNG FUNCTION STABILIZATION OR IMPROVEMENT IS A KEY COMPONENT OF ASTHMA REMISSION<sup>1-7</sup></h2>

<p data-font="legal"><sup>*</sup>Adapted from GINA and ERS/ATS.&nbsp;<sup>†</sup>n=1865; Cox proportional hazard model analysis adjusted for age at index date, smoking status, body mass index, gender, rhinitis, chronic sinusitis, nasal polyps, atopic dermatitis, diabetes, anaphylaxis, ischemic heart disease, heart failure, food allergy, anxiety, depression, and psoriasis.<sup>8 ‡</sup>n=1075; relative risk of death from asthma during 25 years of follow-up.9 ATS, American Thoracic Society; BD, bronchodilator; CI, confidence interval; ERS, European Respiratory Society; FEV<sub>1</sub>, forced expiratory volume in 1 second; FEV<sub>1pp</sub>, FEV<sub>1&nbsp;</sub>percent predicted; GINA, Global Initiative for Asthma; HR, hazard ratio.</p>

<h2 style="text-align: center;">LONG-TERM SYMPTOM CONTROL IS AN IMPORTANT PATIENT-REPORTED COMPONENT OF ASTHMA REMISSION<sup>1-7</sup></h2>

<p data-font="legal"><sup>*</sup>Adapted from GINA and ERS/ATS.<br>
  ACQ, Asthma Control Questionnaire; ACT, Asthma Control Test; ATS, American Thoracic Society; BD, bronchodilator; ERS, European Respiratory Society; FEV<sub>1</sub>, forced expiratory flow in 1 second; GINA, Global Initiative for Asthma.</p>

ON-TREATMENT ASTHMA REMISSION: MOVING BEYOND CONTROL

Discover a solution to control mixed Eosinophilic and Allergic Asthma

<p>Consider this biologic for Patients with mixed Phenotypes.</p>

<p><strong>It’s time to address the full spectrum of Type 2 Inflammation in Asthma 50% to 70%a of adult patients with Asthma have Type 2 Inflammation¹</strong></p>
<h2>GINA Guidelines for difficult - to - treat and severe Asthma</h2>
<h3>Type 2 inflammation is indicated by elevated levels of one or more of the following markers²:</h3>
<ul>
 <li><strong>Blood eosinophils ≥ 150 cells/µL</strong></li>
 <li><strong>Sputum eosinophils ≥ 2 %</strong></li>
 <li><strong>Asthma is clinically allergen-driven IgE ≥ 20 IU/mL</strong></li>
 <li><strong>FeNO ≥ 20 ppb</strong></li>
</ul>
<p>Biomarkers of Type 2 inflammation may be suppressed by systemic corticosteroid use. This should be taken into consideration when determining Type 2 status in patients taking oral corticosteroids³</p>
<p><sup>ᵃ</sup>N=205.<br><sup>ᵇ</sup>N=37.</p>

Abbreviations

<h2>Type 2 Inflammation</h2>
<h3>IL-4 and IL-13: Central Cytokines that mediate Type 2 Inflammation, including Allergic and Eosinophilic<sup>1,2,3</sup></h3>
<h3>Type 2 inflammation plays an important role in uncontrolled asthma, contributing to increased exacerbations and decreased lung function²</h3>

<h2>Type 2 Inflammation CoMorbidities</h2>
<h3>Type 2 Inflammatory Diseases Share Common Inflammatory Cells and Mediators¹⁻³</h3>

<h2>Type 2 Asthma includes a range of phenotypes</h2>
<h3>Type 2 Asthma GINA phenotypes¹</h3>

<h2>Real World Evidence on Pheno Types</h2>
<h3>Saudi Arabia Real World Evidence Data for Mixed Phenotype Refractory Asthma¹</h3>
<h4>From Local Saudi Arabia Data, Almost 78% of Severe Ashtma patients with elevated Serum IgE and eosinophilic count<sup>1</sup></h4>
<p>The 78% mixed phynotyping patients have been subcategorized as following<sup>1</sup></p>

<h3>Methods:</h3>
<p>A retrospective cross-sectional real-life study was conducted on patients attending adult refractory asthma outpatient clinic between 2015 and 2018.<sup>1</sup></p>
<p>Serum total IgE level and blood EOS count on matched dates with spirometry and Asthma Control Test (ACT) scores were collected.<sup>1</sup></p>
<p>All data were obtained while patients were not on biological agents.<sup>1</sup></p>

<p data-font="legal"><strong>Fig. 1.</strong>&nbsp;Serum IgE levels and eosinophils count subgroups of patients with refractory severe asthma.</p>

<h2>Severe Asthma treatment goals</h2>
<h3>Patients with uncontrolled persistent Asthma have a high disease burden<sup>1-9</sup></h3>

<h2>FEV<sub>1</sub>&nbsp;Correlation with AAER</h2>
<h3>Low Fev<sub>1</sub>&nbsp;is a significant predictor of future severe exacerbations</h3>
<p>Patients aged ≥18 years with moderate-to-severe asthma over a 36-month follow-up period (n=1865)</p>

<p data-font="legal">**p&lt;0.01; ****p&lt;0.0001. aCox proportional hazard model analysis adjusted for age at index date, smoking status, BMI, gender, rhinitis, chronic sinusitis, nasal polyps, atopic dermatitis, diabetes, anaphylaxis, ischemic heart disease, heart failure, food allergy, anxiety, depression, and psoriasis. BMI, body mass index; CI, confidence interval; HR, hazard ratioKhan A, et al. Ann Allergy Asthma Immunol. 2018;121:S22–S62</p>

About Type 2 Inflammation – Asthma

Dupixent® (dupilumab) Mechanism of Action

<p>Dupixent binds to IL-4Rα, blocking IL-4 and IL-13 intracellular signaling, Two Type 2 Cytokines that contribute to Inflammation in Asthma.</p>

How does Dupixent support lung function improvement in Pediatric Asthma?

<p>KOL Expert on Lung Function for Pediatric asthma.</p>

Consider Dupixent for Asthmatic patients with high EOS

<p>Dupixent showed great results to control patients exacerbations and improve lung function for Severe Asthmatic patients with high EOS.</p>

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Asthma

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