Biomarkers in Shifting the Treatment Paradigm of Asthma - Episode 14

Final Thoughts on Allergic Asthma

May 19, 2020

Transcript: Thomas Casale, MD: What I’d like to do is to just go around the horn and ask for any last comments. Mike, we’ll start with you.

Michael Wechsler, MD, MMSc: We are at a really exciting time in terms of asthma management, because we now have, just in the last 5 years, several new therapies that have really made a difference for our patients. But I’m afraid that the more we have learned, the more we realize we still don’t know. While we are having great responses to some of the new therapies, there are still many patients who don’t respond. I think we need to keep working on identifying new therapies and new biomarkers. We need to do some new head-to-head studies to help us, as clinicians, decide on 1 therapy versus another.

My other thought that I just wanted to comment on is that right now we are in challenging times, as well, because of the coronavirus. I think it’s going to be important for us to try to understand what the effect of the coronavirus has on our patients with asthma, and also to try to understand how patients with asthma respond to coronavirus. Those are 2 separate questions we need to think about. We need to follow our patients very closely.

Thomas Casale, MD: Shahzad?

Syed Shahzad Mustafa, MD: I certainly echo what Mike said. These are exciting times. We have new therapeutics. We’re learning more and more, but the more we know, the less we know. I’ll take an opportunity here to say that it’s been a pleasure to be part of this panel. I really think that these severe asthmatics, any complicated health issue, will benefit from a multidisciplinary approach. This panel shows that when we have a pulmonologist and an allergist, we all bring something different to the table. Centers that do it well, clinicians that do it well, work together to take care of these severe asthmatics. I encourage that multidisciplinary approach in severe asthma and in any complicated health condition, because the benefits for the patient—and quite frankly professional satisfaction—are significant.

Thomas Casale, MD: Geoff, any last words?

Geoffrey Chupp, MD: Yes, it’s been great to be on this panel, virtually from home, and I enjoyed discussing this with everyone here in the midst of the pandemic. What’s exciting is that we have had amazing results in so many patients with biologics, and we understand the disease much better. But our discussion also really highlights the fact that there are a lot of patients—and we know from the trials—who are not responding. Although we see drugs coming down the pike that are going to probably chip away at that group of individuals, we still have a lot of unmet needs in the disease in terms of reducing exacerbations and improving lung function and potentially achieving remission-level control.

The other thing I’ll put forth is that I believe we really still need critical observational studies that are with an eye toward identifying novel biomarkers, so we can integrate this into how we manage patients to make our approach to treating the disease much more personalized. I think that COVID-19 [coronavirus disease 2019] is going to actually be an important factor for us to deal with going forward as asthma physicians, not just in the acute phases of the pandemic but also probably with aspects of disease that are going to drive asthma going forward in survivors and individuals who were exposed.

Thomas Casale, MD: Yes. Stan?

Stanley Goldstein, MD: First, thank you for a great discussion and being on the panel. But I would like to say this is the best of times and the worst of times. It’s really the best of times for our patients. We do have improved therapies for them. It’s resulting in improvement in quality of life, asthma control, decrease in exacerbations. I could go on and on. However, as was said by Mike, over the years, the more I learn about asthma, I realize that I know less about it. There’s so much more for us to learn.

The important issue is when you think about the treating physicians—the pulmonologists and allergists—who don’t read the literature and are educated by the marketing messages of the pharmaceutical companies, that’s where they start to quote them and try to treat based on that. We have to realize, as we’ve seen in this whole discussion, that it’s like looking at the young child with a board that has different shapes, squares, triangles, and circles. What we try to do is compartmentalize everything. If we take a square piece that says “anti—IL-5,” even though we put it into that square piece, it may not truly fit. There are so many other downstream effects that we are unaware of. That’s what I mean by the worst of times. When we think about the worst of times with respect to coronavirus, we never thought in our life that we would see a viral infection spreading like coronavirus throughout the United States and resulting in mortality. We thought we knew it all, but the issue is we know very little. We know something to help our patients, but we need to know more and understand it better.

Thomas Casale, MD: I would like to thank all 4 of you for a very informative and educational discussion. I learned a lot and appreciate all the work that all of you have done in your careers, taking care of patients and the research that you have all done to advance the science. You guys did a great job, and I would also like to thank HCPLive® for bringing this to everybody, and I hope that the audience can appreciate the complexities of taking care of patients with asthma. And with this underlying pandemic, to really think about how we’re going to manage these patients in the future. Whether they’ll be influenced by having COVID-19, if they have asthma or if they don’t have asthma, they’re more likely to develop it or other lung disorders down the line after they’ve recovered. Challenging times but exciting. Again, thank you all for tuning in and listening.

Transcript Edited for Clarity