Understanding Asthma: Significant Research Contributions from 2017

An international team of respiratory disease specialists looked back at 2017 and assembled a review of the current approaches to asthma and chronic obstructive pulmonary disease (COPD). Published in the journal Respirology, the authors provide exceptional insight into asthma and COPD research and what pharmacists should know and appreciate about these diseases.

The good news is that estimated global asthma mortality in individuals aged 5 to 34 has improved since 1993. The bad news is those improvements stalled between 2006 and 2012.

With respect to asthma, the authors indicated that researchers and clinicians have a better appreciation of how asthma changes as patients age. Today, we tend to address pediatric and adult asthma somewhat differently.

Asthma's severity and risk increases with age, but it's critical to know that children who have severe asthma are more likely to have impaired respiratory capacity later in life. Fractional exhaled nitric oxide (FeNO) levels measured at above 31 ppb can predict asthma exacerbations in children and young adults.

New treatment strategies for asthma are obviously needed since our current treatment strategies do not universally control this disease. While pharmacological management is the cornerstone of treatment, researchers have tremendous interest in the microbiota and use of probiotics. The authors noted that current studies are promising, but additional study in this area is warranted to identify the best probiotic for use in asthma.

Health care providers need to identify and manage comorbidities, which are common in patients who have asthma. Health care providers are doing a much better job at assessing patients for anxiety and depression, but the most common comorbidities are respiratory infections, sinusitis, gastroesophageal reflux disease, and obesity.

Increasingly, researchers are identifying biomarkers that can help target therapy. They are also relying on phenotype. Older adults are less likely to have atopic and eosinophilic phenotypes than younger individuals. However, they have a greater likelihood of irreversible airway obstruction and severe disease than younger individuals.

The authors emphasized that inhaled corticosteroids, an $8 billion global market, remain the cornerstone of treatment. Pharmacists need to establish relationships with patients who have asthma, encourage proper use of inhalers, and monitor adherence closely.

Reference

Benton MJ, Lim TK, Ko FWS, et al. Year in review 2017: Chronic obstructive pulmonary disease and asthma. Respirology. 2018 Mar 4. doi: 10.1111/resp.13285. [Epub ahead of print]