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What is severe eosinophilic asthma (SEA)?

Asthma is a complex heterogeneous disease comprised of different phenotypes with specific clinical and pathophysiological features. 1-4Find out how to identify severe eosinophilic asthma (SEA) and the role of interleukin (IL)-5.

Top 10 severe eosinophilic asthma facts

1. Severe asthma is a heterogeneous disease comprised of different phenotypes with specific clinical and pathophysiological features, characterised by the presence of biomarkers such as eosinophils, periostin, FeNO and IgE. 1-4

2. Eosinophils play a key role in maintaining long-term inflammation and exacerbation risk, under the control of IL-5. 5-7

3. Eosinophil levels are a useful marker for the severity of asthma symptoms and severity in eosinophilic asthma. 8

4. Increased numbers of blood eosinophils are associated with severe eosinophilic asthma exacerbations. 6

5. Severe eosinophilic asthma is an identifiable severe asthma phenotype, characterised by eosinophilic inflammation. 19

6. Nucala is a targeted add-on anti-IL-5 therapy for severe refractory eosinophilic asthma in adults, adolescents and children ≥ 6 years. 10

7. By characterising a patient’s phenotype, you can identify whether they might be suitable for a targeted add-on anti-IL-5 therapy. 10

8. Patients with this phenotype can be identified using medical history and  routine assessments including a simple blood test.

9. Severe asthma carries a significant burden of disease. 1112

34% of severe asthma patients are hospitalised at least once a year, due to continuing symptoms 11

10. Historically, there have been limited treatment options for patients with severe eosinophilic asthma, with many patients continuing to frequently exacerbate despite the current options available 12

Identify your patients with severe refractory eosinophilic asthma

Severe eosinophilic asthma – a type of asthma associated with recurrent exacerbations and eosinophilic inflammation

Severe asthma is “asthma which requires treatment with high-dose inhaled corticosteroids (ICS) plus a second controller (and/or systemic corticosteroids) to prevent it from becoming ‘uncontrolled’ or which remains ‘uncontrolled’ despite this therapy.” 1

Patients whose asthma is uncontrolled have serious exacerbations despite adherence to treatment. These patients may need systemic corticosteroids, or experience hospitalisation or emergency department visits. 1

Severe eosinophilic asthma is a severe asthma phenotype, which is characterised by eosinophilic inflammation. 19

Nucala is a targeted add-on anti-IL-5 treatment option for adults, adolescents and children ≥ 6 years with severe refractory eosinophilic asthma. 10

Our understanding of the severe eosinophilic asthma phenotype is increasing 1

Severe asthma is a heterogeneous disease comprised of different phenotypes with specific clinical and pathophysiological features, characterised by the presence of biomarkers such as eosinophils, periostin, FeNO and IgE. 1-4

Severe eosinophilic asthma is a severe asthma phenotype, characterised by eosinophilic inflammation. 19

Patients with severe eosinophilic asthma can be identified using medical history and routine assessments including a blood test.

Historically, there have been limited treatment options available for adult patients with severe eosinophilic asthma, with many patients continuing to frequently exacerbate despite the current options available. 12

All patients with severe asthma should have their eosinophil levels checked with a routine blood test to find out whether targeted anti-IL-5 add-on therapy might be appropriate for them.

The inflammatory role of blood eosinophils

Eosinophils play a role in maintaining long-term inflammation and exacerbation risk in asthma and are a useful marker for disease severity 5-7

Eosinophilic airway inflammation 14

IL-5 is the major cytokine responsible for the growth, differentiation, recruitment, activation and survival of eosinophils. 15

Eosinophils play a role in maintaining chronic inflammation and exacerbation risk, under the control of IL-5. 5-7

Increased numbers of eosinophils are associated with severe eosinophilic asthma exacerbations. 6

Nucala is a targeted add-on anti-IL-5 treatment option for adult patients with severe refractory eosinophilic asthma. 10Patients who may need treatment for severe refractory eosinophilic asthma can be identified using medical history and routine assessments including a routine blood test.

References:

  1. Chung KF, Wenzel SE, Brozek JL et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014;43(2): 343-373.
  2. Campo P, Rodríguez F, Sánchez-García S et al. Phenotypes and endotypes of uncontrolled severe asthma: new treatments. J Investig Allergol Clin Immunol 2013; 23(2):76-88.
  3. Garcia G, Taillé C, Laveneziana P et al. Anti-interleukin-5 therapy in severe asthma. Eur Respir Rev 2013; 22(129):251-257.
  4. Corren J. Asthma phenotypes and endotypes: an evolving paradigm for classification. Discov Med 2013; 15(83):243-249
  5. Patterson MF, Borish L, Kennedy JL. The past, present, and future of monoclonal antibodies to IL-5 and eosinophilic asthma: a review. J Asthma Allergy 2015;8:125-34. doi: 10.2147/JAA.S74178. eCollection 2015
  6. Malinovschi A, Fonseca JA, Jacinto T et al. Exhaled nitric oxide levels and blood eosinophil counts independently associate with wheeze and asthma events in National Health and Nutrition Examination Survey subjects. J Allergy Clin Immunol. 2013; 132(4):821-7. 
  7. Heaney LG, Brightling CE, Menzies-Gow A et al. Refractory asthma in the UK: cross-sectional findings from a UK multicentre registry. Thorax 2010; 65(9):787-94.
  8. Pavord ID and Bafadhel M. Exhaled nitric oxide and blood eosinophilia: independent markers of preventable risk. J Allergy Clin Immunol 2013; 132(4):828-829.
  9. Wenzel SE. Asthma phenotypes: the evolution from clinical to molecular approaches. Nat Med 2012; 18(5):716-725.
  10. Nucala SmPC.
  11. de Carvalho-Pinto RM, Cukier A, Angelini L et al. Clinical characteristics and possible phenotypes of an adult severe asthma population. Respir Med 2012; 106(1):47-56
  12. Peeters SP, Ferguson G, Deniz Y et al. Uncontrolled asthma: a review of the prevalence, disease burden and options for treatment. Respir Med 2006; 100(7):1139-1151.
  13. Kupczyk M, ten Brinke A, Sterk PJ et al. Frequent exacerbators--a distinct phenotype of severe asthma. Clin Exp Allergy 2014; 44(2):212-221.
  14. Spahn J, Covar R, Stempel DA. Asthma: Addressing consistency in results from basic science, clinical trials, and observational experience. J Allergy Clin Immunol 2002; 109(5, Supplement):S490-S502.
  15. Kouro T and Takatsy K. IL-5- and eosinophil-mediated inflammation: from discovery to therapy. Int Immunol 2009; 21(12):1303-1309.

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