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Biological Asthma & COPD Meds

For anyone interested in in-depth info (current state of play) on Biological Asthma Meds (i.e. those meds typically ending in ‘mab’) there’s an excellent (recent) PDF on the link below.

Note that you may have to copy and paste the link into your web browser if clicking it below does not give you access.

journal.chestnet.org/articl...

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Thanks Matman! An interesting read and I like to keep up with the latest research. Though I felt there was a lot this one didn't address eg why no mention of dupilumab which is in late stage trials for asthma and has similar targets to drugs they did discuss? And no mention at all of asthmatics who do not seem to have eosinophilic inflammation with asthma.

Sorry - I have non-eosinophilic asthma and also write these kinds of articles for a living (working with the researchers) so I get a bit wound up by articles which focus too narrowly on eosinophilia in asthma and don't seem.to acknowledge the variety of types or the existence of asthma, including severe asthma, without significant eosinophilia. I have hopes for dupilumab because it seems to have an effect even with normal blood eosinophil counts, and also for tezepelumab which they do mention here, but don't say acts at an earlier stage in the inflammatory process and therefore is likely to be useful to a wider range of asthma types, including weirdos like me.

I will have a look and share if there is anything you or others may find interesting on this topic.

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Not really related to the article per se but more to the types of Asthma.

I'm trying to understand *why* it is not standard procedure when Asthma as a condition is suspected, that tests are done to find out what *type* of Asthma a person has.

Surely, if there is significant evidence of different types, specific treatments can be used for that *type* of asthma and therefore the patient can get the best treatment for them rather than the "try-this-&-wait-&-see" approach.

I have no idea what my asthma is at the moment. Hoping the specialist will be able to find out.

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I think they are in an in between kind of stage where it is recognised in the research community that there are different types, but this hasn't yet filtered down to a lot of clinicians fully. Even when it has, they don't necessarily have the equipment/full training to integrate them properly.

My impression at the moment is that clinical guidelines are still very much one size fits all (I think that article does say that even if it doesn't acknowledge the breadth of differences). I also think there isn't really much recognition of some of the challenges of using these tests, judging by posts on here. I get a bit pissed off by NICE, and I expect doctors do too, saying things like 'oh you should use FENO as standard in primary care'. Err the machines cost a lot of money and FENO without full training on its interpretation is a bad idea, as it will lead to people who don't have 'that' kind of asthma being told they don't have it at all. Ditto even spirometry when it is used wrong - I think there are medical professionals out there conflating asthma and COPD with spirometry, and I'm pretty sure my former cons used to do that as she had a go at me about why I was walking around normally when I 'claimed' to be bad and need hospital at times. Err because asthma is variable and I didn't claim I was always at the level where I need hospital?!

I feel like the default is allergic asthma and sometimes the more classic versions of eosinophilic if they know about that, and if you don't have the classic signs of that then it is much harder and you're treated with suspicion and sometimes dismissed. But then the same goes for symptoms - there is still an assumption with far too many drs that a wheeze is needed, or a particular peak flow, and even though there are plenty of people just on this forum who don't fit the standard pattern, it can be hard if you don't fit what is 'expected' of asthma and no wide recognition that it isn't a narrow disorder.

Also, there still aren't really treatments for several types of asthma, even when an effort is made to find out what type. My severe asthma clinic went to a lot of effort to work out what was going on with mine and the conclusion was that I don't have the kind that can be treated with the current lot of newer drugs, even though I don't respond fully to the older ones.

Ugh sorry to be so depressing. If it helps, I am better than I used to be, at least in between attacks - seeing someone who knows what they're doing and appreciates I am not classic does help, as it means they listen when I say I'm getting worse. I really hope you also get there and find something that works but I do know exactly how hard it can be so crossing fingers you get things sorted soon and find the right treatment.

I have hopes that we will get to the place that other chronic diseases like rheumatoid arthritis and multiple sclerosis are in, with a larger range of disease-modifying drugs. They have some way to go and aren't nice things to have, but you can eg have remission now from RA which wasn't formerly possible.

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Do recal some mention of Dupilumab in the article, but perhaps not as much detail as for some of the other MABs.

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I was reading on my phone, may have missed it! Was hoping for some discussion alongside the other anti-IL4/IL13 mAbs.

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