Our Centre regularly hosts national and international experts for seminars on topics related to severe asthma. Whenever possible, these asthma seminars will be recorded and made available below.
Obesity is a common co-morbidity associated with severe asthma, which impacts on health outcomes and response to treatment. A multidisciplinary panel of experts present different management approaches for severe asthma, including dietetics, bariatric surgery, endocrinology and clinical psychology.
Prof. Andrew Menzies-Gow (Royal Brompton Hospital) discusses the use of oral corticosteroid (OCS) treatment for severe asthma. While OCS treatment has many beneficial effects, side-effects also contribute to significant disease burden. Strategies that can reduce OCS use while minimising symptoms are recommended, to limit the lifelong impacts of OCS treatment. Strategies to limit OCS use using current strategies and biologic therapy are presented.
A/Prof. David Langton (Peninsula Health) presents an overview of bronchial thermoplasty as a treatment option for severe asthma. The presentation includes a description of the procedure, how it works, the effects of treatment and complications, patient selection considerations and costs.
Dr. Gang Wang (West China Hospital / Sichuan University) presents an overview of studies conducted into severe asthma in China, through the Australasian Severe Asthma Network (ASAN) in China and Beyond. He also presents findings looking at potential links between obesity and asthma in a Chinese population with asthma, as well as interactions between depression and asthma outcomes.
Prof. Frank Thien (Eastern Health, Monash University) presents an update on what has been learned since the tragic thunderstorm asthma events that occurred in Melbourne during the afternoon of 21st November 2016. Key findings from their study demonstrated that Asian or Indian ethnicity and a doctor diagnosis of asthma were each significantly associated with increased risk of life-threatening asthma attacks requiring hospitalisation or causing death. The findings provide important considerations for future healthcare responses and management of thunderstorm asthma.
Dr. Mario Castro, Washington University School of Medicine (St Louis, MO), presents “Severe Asthma Data in SARP”. Dr. Castro presents findings from the Severe Asthma Research Program (SARP), providing insights into severe asthma disease phenotypes and approaches for targeted therapy. He highlights the use of imaging technologies to better understand the lung changes that occur in severe asthma. His findings identify subgroups of patients with specific changes in the lung. The hope is that identification of these subgroups will inform the use of targeted therapies. Dr. Castro also presents data on the effects of dupilumab treatment which showed that dupilumab treatment improves patient outcomes.
Prof. Peter Gibson, University of Newcastle, John Hunter Hospital & Hunter Medical Research Institute, presents “Macrolides in Asthma and COPD”. Prof. Gibson presents an overview of the effects of macrolide treatment, as an add-on therapy for asthma and COPD. Macrolides (e.g. erythromycin and azithromycin) are antibiotic molecules, which also have anti-inflammatory effects. Macrolide treatment improves health outcomes in a range of obstructive airways diseases and is being assessed as a treatment option for asthma and COPD. In asthma and COPD, the primary effect of long-term macrolide treatment is a reduction in exacerbations.
Prof. Janelle Yorke, University of Manchester, UK, presents “Patient Reported Outcomes in Severe Asthma: Fit for Purpose?”. Patient reported outcome measures (PROMs) assess the impact of disease from a patient perspective. PROMs are increasingly used to assess the effects of disease and treatment. A range of health-related quality of life PROMs have been used in asthma studies. However, no PROMs have been developed specifically for severe asthma. Prof. Yorke presents preliminary findings on the development of a severe asthma PROM. This project is a collaboration with Prof. Vanessa McDonald.
Prof. Tim Harrison, University of Nottingham, UK, presents “Can Severe Asthma Exacerbations be Prevented with More Inhaled Steroid? A temporary increase in inhaled corticosteroid (ICS) dose has been recommended to reduce asthma attacks. However, limited data was available to support this recommendation. Prof. Harrison provides an overview of his work on the effect of increased ICS dose on asthma attacks. His initial trial demonstrated that doubling ICS dose did not improve lung function or reduce symptoms. Quadrupling ICS dose had a slight benefit, in a subset of patients. In his most recent study, a 4-fold increase in ICS dose reduced severe asthma attacks by ~20%. Prof. Harrison discusses his findings and compares them to recent studies on the effects of increased ICS dose on asthma outcomes. Travel was supported by AstraZeneca.
Dr. Param Nair, McMaster University, Canada, presents “Pathogenic Autoantibodies in Patients with Severe Eosinophilic Asthma”. It is now well-recognised that significant heterogeneity exists in the type of airway inflammation present and response to therapy, between individuals with asthma. Why persistent eosinophilic lung inflammation occurs in some patients, despite high-dose corticosteroid treatment, remains unclear. Dr. Nair provides evidence that in a subset of patients an autoimmune response develops, which may stimulate continued airway inflammation and have implications on response to targeted therapies. Travel was supported by AstraZeneca.
Prof. Louise Donnelly, from the Imperial College London, presenting on “Defective Innate Immunity in Airway Disease”. Prof. Donnelly’s research focuses on the cellular profile of inflammatory lung diseases, including asthma and COPD. In particular, her work investigates how innate inflammatory cell function is altered in inflammatory disease.
There is increasing recognition that early-life lung development has long-term effects on the development of asthma. Retrospective and longitudinal studies provide evidence that wheeze and impaired lung function in childhood increases the risk of developing lung disease (including asthma and COPD). Factors that affect early life lung development include tobacco smoke exposure, pollution, birth weight, breastfeeding and early-life airway remodelling. There is no single mechanism leading to impaired lung function growth. Rather, many small effects in early life combine to determine long-term outcomes.
Features of asthma and COPD can overlap in the same individual, and contribute to increased disease burden and healthcare costs. An overview of asthma-COPD is provided, with discussion of new treatment options and models of care. A label-free approach which focuses on “treatable traits”, rather than specific disease diagnosis is proposed as a new way forward for the management of obstructive airway disease.
Available at the following link: www.asthma.armchairmedical.tv
Additional presentations from the Australasian Asthma Conference hosted by Asthma Australia are also available.
A podcast with Mic Cavazzini from Pomegranate Health based on a recent “Clinical Perspectives” review published in June’s edition the Internal Medicine Journal entitled “Management of Severe Asthma: Targeting the Airways, Comorbidities and Risk Factors”. This podcast provides up-to-date insights into a number of areas relevant to severe asthma management, including disease endotypes, treatment approaches, trigger factors and comorbidity.
An audio recording is available on the RACP website – Episode 27.
Assessments of patient lung function provide evidence of broad variability between individuals. Prof. Irvin highlights the contribution of airways closing versus narrowing to decreased lung function. Further, in clinical trials, distinct lung function phenotypes exist that do not respond to treatment. Travel was supported by AstraZeneca.
A range of endpoint measures are used in clinical trials assessing novel therapies for asthma. The relative benefits and drawbacks of assessments for severe asthma are discussed. Careful selection of endpoint measures is critical, with consideration of the treatment approach and relevance to patient outcomes.
The recognition that individuals with different phenotypes of severe asthma have differing response to therapy is now well-recognised. While significant progress has been made in our understanding of “eosinophilic” asthma, non-eosinophilic asthma remains poorly understood. Non-eosinophilic asthma is common, although disease mechanisms are poorly understood. Alternate approaches may be required for this population and an improved understanding of the mechanisms of inhaled corticosteroids in this population is required.
Monoclonal antibodies have emerged as options for severe, treatment-refractory asthma. This presentation focusses on the current approved therapies and further treatments in development. It also provides insights into the use of monoclonal therapies in the clinic.
This webinar was hosted by the Centre of Excellence in Severe Asthma on the 2nd of December 2016 in response to the thunderstorm asthma event in Melbourne during the afternoon of 21st November 2016. The purpose of this seminar is to provide insight into what causes thunderstorm asthma and the treatment and management strategies you can use to improve patient outcomes.
An analysis of qualitative semi-structured interviews reveals the emotional and practical impacts of severe asthma, as well as the burden of treatment. The findings indicate the need for acute asthma resources, to improve quality of care and for specific consumer messages about severe asthma.
Occupational asthma is asthma that is caused or worsened by exposure in the workplace environment. Occupational asthma can be subdivided into sensitiser-induced and irritant-induced subtypes. Insights are provided for the diagnosis and management of occupational asthma, with a focus on sensitiser-induced occupational asthma.
Biomarkers can provide insight into the differing mechanisms underlying disease in individual patients. Blood eosinophils are proposed as a useful biomarker in COPD, identifying a patient group that is more likely to respond to steroid therapy. Travel was supported by Menarini.
Clinical assessment in difficult-to-treat asthma is complex and a range of mechanisms underlie severe disease in individual patients. A stratified medicine approach aims to optimise the diagnosis and treatment to individual patients. Biomarker assessment is proposed to inform this approach, with a focus on poor adherence, predicting response to corticosteroids and to inform the use of targeted therapies.
Breathing training exercises are a non-pharmacological approach to manage breathlessness. There is now high-quality evidence for their efficacy in asthma. An overview is provided of breathing disorders and overlap with asthma, and training approaches to improve asthma control and quality of life.
Paradoxical vocal fold movement (PVFM) refers to adduction of the vocal folds during inspiration, and can contribute to breathlessness. PVFM can be misdiagnosed as asthma, but can also co-occur. An overview of diagnosis and speech pathology treatment is provided.
Non-pharmacological approaches are an important aspect of asthma management. However, limited high-quality evidence exists for many approaches. Key factors to consider when designing and interpreting clinical trials are discussed. These include a clear statement of the research question, the choice of comparator, outcomes measures, study blinding and patient involvement.