The Evolving Role of Biologics and TSLP Inhibition in Severe Asthma and Upper Airway Disease - Episode 13
Remission in Severe Asthma: Aligning Physician Goals with Patient Goals
Clinicians define control as no exacerbations and no hospital stays. Dr. Ross argues patients define it differently, and that the gap between the two should drive treatment decisions.
This episode, "Remission in Severe Asthma: Aligning Physician Goals with Patient Goals," features the panel setting the practical issues aside to ask what success looks like.
Dr. Chupp reframes the discussion around the patient. The goal is no longer stopping exacerbations; it is remission. He imagines patients on an injection monthly or every six months with only a rescue inhaler, rather than stacking inhaled therapies plus a biologic just to avoid prednisone twice a year. The obstacle is insurance and the absence of randomized data, though observational and retrospective data support it.
Dr. Ross describes triage: allergists control the most life-threatening problem first, and severe asthma still carries mortality risk. Once that fire is out, the prevention work begins with allergen immunotherapy and household control measures. She then makes a pointed argument about case-finding. GINA reserves biologics for severe asthmatics, but she believes severe patients are being missed and put in the wrong bucket. They go to urgent care and cannot get in with a physician. History-taking is long, but it identifies the patient with an FEV1 of 85 who visited urgent care four times last year and is oral steroid-dependent. That patient is high risk and is not being reported.
She also cites data that controlling atopic dermatitis calms the type 2 cascade and improves both asthma and allergic rhinitis, supporting treatment of the whole systemic condition.
Asked about switching, Dr. Ross says remission is the goal for everybody, but it requires shared decision-making. Physicians set goals like no exacerbations and staying out of hospital. Patients want to play with their kids, sleep well, or visit an amusement park without shortness of breath. When a clinician calls a patient controlled and the patient disagrees, she switches the biologic. Emerging agents targeting TSLP and IL-13, or IL-4, IL-5, and IL-13, plus ultra-long-acting options, make her optimistic.
Up next, in "Selecting a Biologic in Severe Asthma: Biomarkers, Comorbidities, and Payers," Dr. Hanania explains how he chooses among them.
