ASTHMA

RESPIRATORY

Why is it important to measure FEV1 in patients with asthma?

Dupixent Asthma KOL Expert Series Video - Lung Function.

What feedback have you received from patients being treated with Dupixent?

Dupixent Asthma KOL Expert Series Video - DUPIXENT Patient Perspective.

What gives you confidence that Dupixent improves patients’ quality of life?

Dupixent Asthma KOL Expert Series Video - Quality of Life.

What's possible when their Child's Asthma is under control?

When the symptoms are not under control, the airways can become inflamed making breathing difficult. Whilst Asthma cannot be cured, the symptoms can be controlled enabling people with Asthma to live full lives.

What beneficial impact does Dupixent have on OCS-Dependent patients?

Dupixent Asthma KOL Expert Series Video - OCS-Sparing.

Asthma Control Tests (ACT) overview

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

Asthma Assessment Tools (EPOS)

Dr. Janan Abduwani explains the use of the assessment tools (both subjective and objective tools) and provides an overview on the EPOS guidelines.

Prevalence of Asthma

Dr. Emad Arafa explains the prevalence of severe asthma in Middle East and North Africa, in comparison with the global prevalence.

Open Up a World Beyond Their Asthma Symptoms

For results they can feel, prescribe DUPIXENT to target type 2 inflammation, treat OCS-dependent and type 2 asthma patients, and transform their lives with rapid, sustained control... Choose DUPIXENT to open up a world beyond their asthma symptoms.
1. IL-4 and IL-13, two key and central drivers of type 2 inflammation 
 2. TREAT OCS-dependent patients3 &amp; Type 2 asthma patients 
 3.&nbsp;TRANSFORM patient lives beyond symptoms
<ul>
 <li>86% of patients reduced or eliminated OCS while maintaining asthma control3,a</li>
 <li>Up to 550 mL improvement in FEV16,b</li>
 <li>Up to 75% exacerbation reduction6,c</li>
</ul>

Managing Severe Asthma and CRSwNP through the lens of type 2 inflammation

EAACI Satellite Symp. Video Recording : Type 2 Inflammation.

How to inject Dupixent


Dupixent reduce Asthma Exacerbation across different type of patients

Dupixent Asthma Exacerbation Reduction Animation different phenotype.

How does Dupixent target the underlaying type2 inflammation in asthma?

Dupixent Asthma KOL Expert Series Video - Getting to the Source.

Dose a Pediatric indication give you a confidence to prescribe Dupixent?

KOL expert on Dupixent safety for Pediatric Asthma.

How does Dupixent help reduce asthma exacerbations across multiple phenotype.

Dupixent Asthma KOL Expert Series Video - Exacerbations.

<h2 style="text-align: center;">In pediatric asthma patients, FeNO can be a useful marker to:</h2>

<h2 style="text-align: center;">FeNO is the only noninvasive point-of-care test to rapidly assess&nbsp;type 2 inflammation&nbsp;13,14</h2>
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 <td style="text-align: center; background-color: rgb(21, 144, 165);">
 <h3>FeNO is produced in the asthmatic airway as a result of elevated key and central type 2 cytokines IL-13 and IL-44,5,15-17</h3></td>
 </tr>
 </tbody>
</table>

ERS, European Respiratory Society;&nbsp;FeNO, fractional exhaled nitric oxide;&nbsp;GINA, Global Initiative for Asthma;&nbsp;IL, interleukin;&nbsp;iNOS, inducible nitric oxide synthase;&nbsp;ppb, parts per billion.&nbsp;1.&nbsp;Smith AD, et al.&nbsp;Am J Respir Crit Care Med.&nbsp;2005;172(4):453-459.&nbsp;2.&nbsp;Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. Accessed January 18, 2024. https://ginasthma.org/2023-gina-main-report/.&nbsp;3.&nbsp;Peters MC, et al.&nbsp;Curr Allergy Asthma Rep. 2016;16(10):71.&nbsp;4.&nbsp;Katial RK, et al.&nbsp;J Allergy Clin Immunol Pract.&nbsp;2017;5(2S):S1-S14.&nbsp;5.&nbsp;Parulekar AD, et al.&nbsp;Curr Opin Pulm Med.&nbsp;2016;22(1):59-68.&nbsp;6.&nbsp;Gaillard EA, et al. European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years.&nbsp;Eur Respir J.&nbsp;2021;58(5):2004173.&nbsp;7.&nbsp;Ferraro VA, et al.&nbsp;J Clin Med.&nbsp;2019;8(11):1783.&nbsp;8.&nbsp;White MP, et al.&nbsp;J Asthma Allergy. 2020;13:11-22.&nbsp;9.&nbsp;Kim JK, et al.&nbsp;Respirology.&nbsp;2017;22(3):466-472.&nbsp;10. Diamant N, et al.&nbsp;Pediatr Pulmonol.&nbsp;2021;56(6):1449-1454.&nbsp;11. Di Cara G, et al.&nbsp;Pediatr Allergy Immunol.&nbsp;2015;26(1):85-87.&nbsp;12. di Palmo E, et al.&nbsp;Int J Mol Sci. 2021;22(9):4651.&nbsp;13.&nbsp;Kuo CR, et al.&nbsp;Respir Med.&nbsp;2019;155:54-57.&nbsp;14. Bjermer L, et al.&nbsp;Respir Med.&nbsp;2014;108(6):830-841.&nbsp;15. Prado CM, et al.&nbsp;ISRN Allergy. 2011:832560.&nbsp;16. Alving K, Malinovschi A. Basic aspects of exhaled nitric oxide. In: Horvath, de Jongste JC, eds. Exhaled Biomarkers. European Respiratory Society; 2010:1-33. European Respiratory Monograph No. 49.&nbsp;17.&nbsp;Munakata M.&nbsp;Allergol Int. 2012;61(3):365-372.

FeNO Is a Clinically Useful Biomarker of Type 2 Inflammation in Pediatric Patients With Asthma

When do you discuss Biologic treatment with your Asthma patients?

A Biologic option in severe Asthma

What is your experience with Dupixent in your practice?

Dupixent Asthma KOL Expert Series Video - DUPIXENT in Your Practice.

Severe Asthma Biomarker's

What is the clinical utility of monitoring changes in eosinophils, IgE, and fractional exhaled nitric oxide (FeNO) to assess the effectiveness of biologic treatments?
Eosinophils and FeNO - these clinical measurements can help us predict exacerbation risk and make wise decision on biological options.1&nbsp;What is the clinical utility of monitoring changes in eosinophils, IgE, and fractional exhaled nitric oxide (FeNO) to assess the effectiveness of biologic treatments?

References

Spirometry&nbsp;is the gold standard to assess lung function2.
Lung function assessment&nbsp;can1:
<ul>
 <li>Diagnose pulmonary disease</li>
 <li>Monitor disease progression</li>
 <li>Monitor treatment response</li>
</ul>

Lung Function Decline and Exacerbation in Asthma

Impact of reduced lung function2
<ul>
 <li>Shortness of breath</li>
 <li>Increased exacerbation risk</li>
 <li>Reduced exercise tolerance</li>
 <li>Impaired gas exchange resulting&nbsp; in hypoxemia and hypercapnia</li>
</ul>

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

OCS Video

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. These effects include but not limited to:

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

Choosing the right Biologic for Severe Asthma patients.

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

Treatment challenges&nbsp;in Severe Asthma.

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?

&nbsp;KOL Expert on Asthma Control and Quality of Life for Pediatric.

FeNO Video

FENO: Direct measure of local airway inflammation in asthma
Predictor of:
<ul>
 <li>Loss of asthma control</li>
 <li>Risk of exacerbation</li>
 <li>Lung function decline</li>
 <li>Simple, noninvasive method.</li>
</ul>

Could clinical remission in asthma disease be achievable?&nbsp;
Patients who achieve complete remission will have evidence of no inflammation in their airway when you look down their airway through either bronchoscopy or biopsies of their airway. Currently, the clinical remission is not based on the inflammatory component of the disease, it's mainly based on lung function, asthma control, exacerbation reduction, and elimination of oral corticosteroids2.

Clinical Remission Video

Asthma treatment Goals will outline, which are:&nbsp;1
<ul>
 <li>Improve symptoms of the patient.&nbsp;1</li>
 <li>Improve lung function.&nbsp;1</li>
 <li>Decrease exacerbation.&nbsp;1</li>
 <li>Enhance quality of life.&nbsp;1</li>
 <li>Decrease hospital admission.&nbsp;1</li>
 <li>Improve lung function.&nbsp;1</li>
</ul>

Consider Dupixent for Asthmatic patients with OCS use

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

Airway Hyperresponsiveness
in Asthma

<h2 style="text-align: center;">Proposed Framework for Remission1-7</h2>

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 <h3 style="text-align: center;">Remission: A state or period with low to no disease activity that can be spontaneous or as a result of therapy6</h3></td>
 </tr>
 </tbody>
</table>

<h3 style="text-align: center;">Several Countries Have Recommended Clinical Remission Definitions1-5</h3>

*A broad consensus definition is being developed with over 120 experts and is expected in the GEMA 5.4 update.
†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.

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 <h3 style="text-align: center;">The definition of on-treatment remission in asthma has not yet been established and further consensus among experts, guidelines, and societies is warranted.6</h3></td>
 </tr>
 </tbody>
</table>
This tool showcases the evolving evidence around asthma remission as of February 2024 and is intended for educational purposes only.
ACQ, Asthma Control Questionnaire; ACT, Asthma Control Test; AirQ, Asthma Impairment and Risk Questionnaire; FEV1, forced expiratory volume in 1 second; ICS, inhaled corticosteroids; OCS, oral corticosteroids.

<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?6-10</h3>

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

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 <tbody>
 <tr>
 <td style="background-color: rgb(21, 144, 165);">
 <h3 style="text-align: center;">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.6</h3></td>
 </tr>
 </tbody>
</table>
This tool showcases the evolving evidence around asthma remission as of February 2024 and is intended for educational purposes only.
ICS, inhaled corticosteroids; LABA, long-acting beta agonist; SABA, short-acting beta agonist; SCS, systemic corticosteroids.

<h2 style="text-align: center;">REDUCING EXACERBATIONS IS A FUNDAMENTAL CRITERION OF ASTHMA REMISSION1-7</h2>

*Adapted from GINA and ERS/ATS.&nbsp;†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; FEV1, forced expiratory volume in 1 second; GINA, Global Initiative for Asthma.

<h2 style="text-align: center;">ZERO OCS USE IS REQUIRED FOR A STATE OF ASTHMA REMISSION1-7</h2>

*Adapted from GINA and ERS/ATS.&nbsp;†P&lt;0.001.20 
 AE, adverse event; ATS, American Thoracic Society; ERS, European Respiratory Society; GI, gastrointestinal; GINA, Global Initiative for Asthma; OCS, oral corticosteroids.

<h2 style="text-align: center;">ACHIEVING LUNG FUNCTION STABILIZATION OR IMPROVEMENT IS A KEY COMPONENT OF ASTHMA REMISSION1-7</h2>

*Adapted from GINA and ERS/ATS.&nbsp;†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.8 ‡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; FEV1, forced expiratory volume in 1 second; FEV1pp, FEV1&nbsp;percent predicted; GINA, Global Initiative for Asthma; HR, hazard ratio.

<h2 style="text-align: center;">LONG-TERM SYMPTOM CONTROL IS AN IMPORTANT PATIENT-REPORTED COMPONENT OF ASTHMA REMISSION1-7</h2>

*Adapted from GINA and ERS/ATS. 
 ACQ, Asthma Control Questionnaire; ACT, Asthma Control Test; ATS, American Thoracic Society; BD, bronchodilator; ERS, European Respiratory Society; FEV1, forced expiratory flow in 1 second; GINA, Global Initiative for Asthma.

ON-TREATMENT ASTHMA REMISSION: MOVING BEYOND CONTROL

Discover a solution to control mixed Eosinophilic and Allergic Asthma

Consider this biologic for Patients with mixed Phenotypes.

Open up a world beyond their Asthma symptoms

Give Patients results they can feel with Dupixent.

<h2>It’s Time to Address the Full Spectrum of Type 2 Inflammation in Asthma50%&nbsp;to&nbsp;70%a&nbsp;of Adult Patients with Asthma Have Type 2 Inflammation 1</h2>
<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>Blood eosinophils ≥ 150 cells/µL
 <ul>
 <li>Sputum eosinophils ≥ 2 % 
 &nbsp;</li>
 </ul></li>
 <li>Asthma is clinically allergen-driven IgE ≥ 20 IU/mL 
 &nbsp;</li>
 <li>FeNO ≥ 20 ppb</li>
</ul>
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
ᵃN=205. ᵇN=37.
Abbreviations
GINA, Global Initiative for Asthma;&nbsp;ICS, inhaled corticosteroid;&nbsp;LABA, long-acting beta agonist.

<h2>Type 2 Inflammation</h2>
<h3>IL-4 and IL-13: Central Cytokines that mediate Type 2 Inflammation, including Allergic and Eosinophilic1,2,3</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>

Abbreviations
ABPA, allergic bronchopulmonary aspergillosis;&nbsp;COPD, Chronic Obstructive Pulmonary Disease;&nbsp;CRSwNP, chronic rhinosinusitis with nasal polyps;&nbsp;InterILC2, group 2 innate lymphoid cell;&nbsp;LC, Langerhans cell;&nbsp;NSAID-ERD, nonsteroidal anti-inflammatory drug exacerbated respiratory disease;&nbsp;Th, T helper cell

<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 count1</h4>
The 78% mixed phynotyping patients have been subcategorized as following1

<h3>Methods:</h3>
A retrospective cross-sectional real-life study was conducted on patients attending adult refractory asthma outpatient clinic between 2015 and 2018.1
Serum total IgE level and blood EOS count on matched dates with spirometry and Asthma Control Test (ACT) scores were collected.1
All data were obtained while patients were not on biological agents.1

Fig. 1.&nbsp;Serum IgE levels and eosinophils count subgroups of patients with refractory severe asthma.

Reference

<h2>Severe Asthma treatment goals</h2>
<h3>Patients with uncontrolled persistent Asthma have a high disease burden1-9</h3>

<h2>FEV1&nbsp;Correlation with AAER</h2>
<h3>Low Fev1&nbsp;is a significant predictor of future severe exacerbations</h3>
Patients aged ≥18 years with moderate-to-severe asthma over a 36-month follow-up period (n=1865)

**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

About Type 2 Inflammation – Asthma

Dupixent® (dupilumab) Mechanism of Action

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

How does Dupixent support lung function improvement in Pediatric Asthma?

KOL Expert on Lung Function for Pediatric asthma.

Consider Dupixent for Asthmatic patients with high EOS

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

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Asthma

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