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Asthma is the most common chronic respiratory disease. Some patients develop a severe form of the disease that requires specialist treatment. What drugs are used in Poland and what are the effects? Dr. Aleksandra Kucharczyk from the Department of Internal Diseases, Pneumology, Allergology and Clinical Immunology of the Military Institute of Medicine in Warsaw talks about it.
- Patients with severe asthma can benefit from biological treatment, which gives very good results
- Unfortunately, the problem is the availability of this therapy
- The doctor says what is the biggest problem in the effective treatment of asthma in Poland
- You can find more such stories on the TvoiLokony home page
Journalists for Health Association: For over a year now, when we talk about any disease, we most often consider it in the context of a pandemic. What is the situation for patients with severe asthma?
Aleksandra Kucharczyk, MD, PhD:Epidemiology has not changed, there are as many patients as before. However, the problem is the admission of patients to treatment centers. Some of these highly specialized centers have been transformed into covid centers and patients with severe asthma do not find help there.
Asthma is the most common chronic respiratory disease. Are there many patients with its severe form?
It is estimated that they constitute about 5 percent. suffering from asthma. It does not seem to be a lot, but in fact it is these patients who require the most time, the greatest help, they end up in hospitals and emergency departments. They too need the most advanced therapies.
Are the causes of severe asthma known?
We don’t really know why a patient who has had allergic asthma and has responded well to medications suddenly stops responding to them. There are known risk factors, such as environmental pollution and smoking, but we believe genetic predisposition to do so. Then we observe steroid resistance, no response to standard anti-inflammatory treatment, this severe form of asthma appears.
How is severe asthma treated?
This is called GINA Grade 5 treatment, the world standard of asthma management. We administer high doses of inhaled steroids and additional asthma control medications, yet we fail to control the disease. Depending on the type, i.e. the phenotype of asthma, we decide on the further management.
For some patients, we can offer biological therapy, i.e. therapy aimed at a specific mechanism of inflammation. If the patient has allergic asthma, we suggest treatment with anti-IgE antibodies, because they are responsible for the development of the disease. If we are dealing with eosinophilic asthma, we can block interleukin 5. The real point is that we are hitting a very specific mechanism in a specific way. It is an extremely effective and safe therapy.
Polish patients have had access to biological treatment since 2013. The effects are spectacular, aren’t they?
That’s true. The effects can be seen after 16 weeks, sometimes 24 weeks after starting therapy. There are patients who react even after a few days. These are most often patients who have previously been treated with systemic steroids, drugs that are burdened with large side effects. When biological treatment is turned on, they suddenly start to function perfectly. It happens that we also reduce the doses of inhaled drugs that they took. Their reality changes dramatically: they can just live a normal life.
It is also important that biological therapy is effective at over 90%. These are really remarkable results. The problem is that, unfortunately, still too few patients go to our specialist centers.
There are about 1,5 thousand in drug programs. There are definitely more people, patients who need such treatment.
What it comes from?
We talk about it very often in the group of experts. Despite eight years of treatment options, we still fail to reach the doctors who deal with patients on a daily basis and who should refer them to a specialized center. In a situation where a patient is taking systemic steroids due to an exacerbation of asthma, he should immediately come to us.
Perhaps the reason is also a small number of centers. There are 47 such institutions for adults and 7 for pediatric patients in Poland. In the vast majority of provinces, there are at least two centers treating severe asthma, so it would seem that everyone who needs biological treatment should have access to them. This is unfortunately not the case.
For me personally, however, it seems that the biggest problem appears on the link: the general practitioner and the specialist center. The doctor prescribes systemic steroids, but is not sensitive to checking whether biological therapy would be a better, more effective solution.
Has the year of the pandemic changed the situation for people with severe asthma?
I am sorry to say that it has not been a good year. It is more difficult for patients to get to the doctors, and a much smaller number of patients have been included in biological treatment. On the other hand, there was a significant facilitation in the form of the possibility of using the therapy at the patient’s home. Previously, every dose of the drug had to be administered at the center, now we can distribute it to the patient at home. This is a significant convenience for everyone, unfortunately, it still does not translate into an increase in the number of people undergoing biological therapy. Patients stayed at home, doctors prescribe systemic steroids, and some centers do not accept patients with severe asthma.
It happens that due to a pandemic, patients stop biological therapy?
Our patients are educated. They know that controlled asthma does not increase the risk of developing COVID-19. It would be much more dangerous to give up therapy and return to ailments. It happened that someone was afraid of the long hours of public transport to the center, but it ended up postponing the visit.
How long does biological treatment take?
This is a very important point. Unfortunately, we do not have any studies on the basis of which it is possible to decide on the length of therapy. We operate based on current experience and intuition. However, the provisions of the drug program are such that the therapy must be discontinued in patients after two years. Fortunately, this is a suspension, not an end to treatment. If the patient’s condition worsens, treatment may be restarted. This happens in 95 percent. cases. Therefore, we do not know how long we should use biological treatment of patients with severe asthma, but we know that two years is too short to achieve a long-lasting effect and, from the medical point of view, the therapy should be continued
Have scientific societies made specific recommendations for patients with severe asthma? What about vaccinations?
The most important thing is that patients do not stop their current therapies, including those with systemic steroids. With well-controlled asthma, the possible course of COVID-19 will be that of other patients.
As for preventive vaccinations, each is of great importance. Let’s keep an eye on the vaccination schedule, follow the recommendations, and protect ourselves and others. This applies not only to patients with severe asthma.
Severe asthma is a disease that we can treat effectively and safely today. Remember that overuse of systemic steroids and reliever medications does not bring long-term improvement to patients. Side effects appear, disability occurs, mortality increases.
By referring these patients to specialized centers, we provide them with proper conduct, effective treatment and a normal life.
Authorized press interview prepared by the Journalists for Health Association in connection with the 19th edition of the Quo Vadis Medicina workshop, entitled How to treat asthma in the time of the COVID-2021 pandemic? Organized on the occasion of World Asthma Day, April – May XNUMX.
The symptoms of asthma are relieved by nebulization. Buy the Nebulizer – Neno Sente Compressor Inhaler or the Neno Bene Mobile Nebulizer now at Medonet Market.
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