Biologic Treatment Considerations for Asthma During the COVID-19 Pandemic and the Upcoming Flu Season - Episode 6
Stanley Goldstein, MD: When you think about biologics and the percentage of patients in the United States who have moderate to severe uncontrolled asthma. About 5% to 10% of the patient population in the United States has moderate to severe uncontrolled asthma. If you put that in numbers, it’s about one million to two million patients. There are 25 million people in the United States who have asthma, so that amounts to about one to two million patients who you would think may deserve a biologic. When we think about the uptake of biologics, how many patients would you say are being treated with biologics at this point in the United States? And the question really points to our specialists, including ourselves as allergists and pulmonologists, are they using the biologics, or maybe they are still missing those patients who deserve biologics? So let’s think about that in numbers. At this point in time, maybe 100,000-plus patients in the United States are receiving biologics for the treatment of uncontrolled asthma, and you put that into the numbers, that means there are probably at least another 900,000 patients or 800,000 patients continue to not be treated with biologics when you would think they would deserve a biologic. Would you agree to say that even though allergists, pulmonologists, respiratory specialists if you want to call them, are still missing a lot of patients when you think about those patients who would deserve to be treated with a biologic?
Giselle Mosnaim, MD, MS: I would agree that there are many patients that would require a biologic. Patients that are using their medications, are using them properly, and despite high-dose inhaled steroid plus another controller are still struggling and having to go on oral steroids. I think on a regular basis, I am seeing these patients referred to me in my practice, and I put them on a biologic and that can be life-changing for these patients. That’s an amazing thing as a physician, to be able to make a dramatic improvement in an individual’s quality of life.
Shahzad Mustafa, MD: .. there’s a lot that varies regionally in access to specialists, also. It depends on where you live and the patterns there. As you said, respiratory specialists, allergists, pulmonologists are comfortable with biologics, but we have to see the individual. It’s really important to raise awareness with the primary care community, about that these drugs are available, they are efficacious, they are safe, and with each passing day the FDA approval of the age on these biologics is getting lower and lower. We’re down to age six now, which gives us an opportunity to help these individuals who may not have had options before. Raising awareness is always a good thing, educating our referral base, working with them, so we can have a team approach. We have tools now that we didn’t have years ago, and it’s a privilege to offer them to patients and see their excellent response.
Giselle Mosnaim, MD, MS: One of the things that I’m also excited about and that is currently available, and I’m hoping that we will start to use this more, is remote monitoring. If a patient can have an inhaler that has a Bluetooth monitor on it, so that every time the patient takes a dose of their inhaled steroid or takes a dose of their quick reliever medication, this information gets sent to their personal app, so they can monitor their asthma. They can monitor their adherence to the inhaled steroid, they can self-monitor overuse of bronchodilators, and this information can also go to a clinician’s dashboard. So physicians and other health care providers can see remotely if a person is overusing their albuterol, if a person has not taken their inhaled steroid in a number of days, and there can be automatic alerts set up for patients and for clinicians so we can start to see really what’s going on. Is the patient uncontrolled because they’re either not taking their inhaled steroid, or they’re taking it, but they’re not taking it properly? Are they overusing their rescue medications in certain situations; for example, are they using a lot of albuterol for nighttime symptoms? So really trying to get a better understanding.
These apps can also look at location though GPS, so you can look at air pollution levels, air quality levels. So, we’re really going to be able to get a better idea of what’s going on in the asthma patient’s day-to-day life. The patient will get that feedback to themselves on the app, they can self-monitor better, and clinicians can assist a patient better. If we see that they’re taking their inhaled steroid regularly, they have good technique so we can measure peak inspiratory flow, the app can tell the patient “You had good flow, you had inadequate flow” the physician can know if the person had good peak inspiratory flow, if the medicine was delivered to the lungs. Ifsomeone is taking their medications, it’s getting delivered to the lungs, they’re doing all these things and they’re still having to go on oral steroids or have emergency room visits or hospitalizations, then that’s a time that we would think that this is a severe asthmatic.
Transcript Edited for Clarity