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Living with severe asthma

What makes severe asthma different from mild-moderate asthma?

When you have mild-moderate asthma, it is relatively “easy” to achieve good asthma control. You should be able to manage your condition well so that you do not have daily symptoms and you can lead a relatively normal life.

But when you have severe asthma, it is a greater challenge (but NOT impossible!) to achieve asthma control. It may be more challenging for both you and your healthcare providers to determine which treatments best control your daily symptoms and prevent asthma attacks.

Severe asthma requires a different level of care, including the use of more types of asthma treatments and higher doses of medications.

It’s important to remember that severe asthma CAN be controlled with the right therapy, and that not all uncontrolled asthma is severe!

A patient experience example

Lara has moderate asthma. By following her Asthma Action Plan, she’s able to manage it with just a couple of medications – she uses a daily controller puffer and keeps her reliever puffer on hand in case she needs it. Lara’s airways are more sensitive than someone who doesn’t have asthma and she still has to avoid her triggers, but she doesn’t have daily symptoms impacting her activities. As long as her asthma is under control, Lara doesn’t feel held back by it. Lara loves to exercise!

Lisa has severe asthma. Because her asthma is more severe, Lisa takes a biologic therapy in addition to higher doses of some of the same medication that Lara uses. Lisa also sees a specialist to keep her breathing in check. By following her Asthma Action Plan, avoiding her triggers and exploring new treatments with her healthcare providers, Lisa is able to maintain control over her severe asthma and live the active lifestyle she loves!

The good news: with the right therapy, even severe asthma can be controlled

Yes, you CAN manage your severe asthma!

In addition to the controller and reliever inhalers used by most people with asthma, you may simply require additional treatments in order to achieve good asthma control.

Because treating severe asthma is NOT one-size-fits-all, it is important for patients to be aware of their treatment options so they can discuss them with their healthcare providers:

Individualized treatment plans— the right medication for the right patient at the right time

Once you have a proper diagnosis – through a clinical exam, patient history and spirometry testing – a tailored, personalized treatment plan should be established.

A referral to a specialist may be a necessary next step to determine which treatments will help you gain control of your asthma – and whether your unique immune system and other factors make you a candidate for cutting edge treatment like biologics.

Work with your healthcare providers to determine what combination of the following treatments will work best for you.

The newest treatments for severe asthma: Biologics

Biological medications, often called biologics, are a relatively new type of medication for asthma. Compared to most medications that are made using chemical reactions, biologics are made using living systems (like bacterial/viral cells, plant or animal cells). An example of a common biologic is the flu vaccine, which is usually grown in chicken eggs.

Biologics are designed to inhibit certain components of the immune system that trigger inflammation—and it is inflammation in the airways that causes a lot of your asthma symptoms.

Biologics for treating asthma now include Xolair® (available since 2005), Cinqair™, Nucala™ and Fasenra®.

According to The Lung Association’s 2018 Asthma Survey, sixty-three per cent of asthma patients have never discussed biologics as an option with their healthcare provider[i]. This indicates that greater awareness of respiratory biologics is needed, by both healthcare providers and patients!


Xolair®

Medication class: IgE-neutralizing antibody (Anti-IgE)

What it is: Xolair® is given to you by an injection (shot) from a healthcare professional every two to four weeks. You will still need to continue using all of your asthma medication as prescribed by your healthcare provider.

Who it’s for: Xolair® may be prescribed to reduce the symptoms of asthma due to allergic triggers for individuals aged 12 and older.

How it works: Immunoglobulin E (IgE) is a type of protein that our bodies naturally make in small amounts. In allergic asthma the IgE increases abnormally, causing swelling and tightening of the airways. Anti-IgE therapy reduces the ability of IgE to cause symptoms. Possible side effects should be explained to you by your healthcare provider.

 

Cinqair™, Nucala™

Medication class: Interleukin-5 (IL-5) inhibitor

What it is: Cinqair™ is given to you by intravenous infusion (IV) by a healthcare professional every four weeks. Nucala™ is given to you by subcutaneous injection (just-under-the-skin shot) by a healthcare professional every four weeks. You will still need to continue using all of your asthma medication as prescribed by your healthcare provider.

Who it’s for: IL-5 inhibitors are sometimes prescribed for the maintenance treatment of severe asthma in patients aged 18 years or older. IL-5 inhibitors are only effective for people who have a certain level of eosinophil, a type of white blood cell in your blood. Your healthcare provider will check your blood eosinophil level before prescribing the medication.

How it works: IL-5 inhibitors may be added if your asthma is not under control despite using medium to high doses of inhaled corticosteroids plus another controller medication. Possible side effects should be explained to you by your healthcare provider.

 

Fasenra®

Medication class: Anti-eosinophil (anti-interleukin-5 receptor alpha monoclonal antibody)

What it is: Fasenra® is given to you as an injection just under the skin (subcutaneously) by a healthcare professional. The injection is given every 4 weeks for the first 3 injections, and then every 8 weeks thereafter. You will still need to continue using all of your asthma medication as prescribed by your healthcare provider.

Who it’s for: Fasenra® is used for the maintenance treatment of adult patients with severe eosinophilic asthma, whose asthma is not controlled with their current asthma medicines. Severe eosinophilic asthma is a type of asthma where patients have increased eosinophils in the blood or lungs. You will still need to continue using all of your asthma medication as prescribed by your healthcare provider.

How it works: Eosinophils are a type of white blood cell that are associated with inflammation of the airways that can cause your asthma to get worse or can increase the number of asthma attacks. Fasenra works by reducing the number of eosinophils in the blood and lungs and helps reduce the number of asthma attacks that you experience. Possible side effects should be explained to you by your healthcare provider.

 


[i] Leger. (2018). Lung Association of Canada, 2018 Asthma Survey

Other treatments for severe asthma

Antileukotriene pills

Examples: Accolate®, Singulair®

Antileukotriene pills can help to prevent your asthma symptoms. They may be prescribed as an additional daily medication along with optimal treatment with an inhaled corticosteroid. Possible side effects should be explained to you by your healthcare provider.

 

Oral corticosteroids

Examples: Prednisone, Prednisolone, Dexamethasone

Oral Corticosteroids (or OCS) are sometimes prescribed for several days to treat an asthma attack. These pills may also be prescribed for long-term daily use if your asthma is not well-controlled despite optimal treatment with an inhaled corticosteroid plus additional therapy.

Possible side effects should be explained to you by your healthcare provider, but may include weight gain, bruising and mood changes. Relying on oral corticosteroids may also indicate that asthma treatment is not working.

Because of these factors, patients taking regular courses of OCS could be considered for treatment using respiratory biologics. These other treatment options could significantly improve your quality of life.

 

Bronchial thermoplasty

Bronchial thermoplasty is a medical procedure that uses mild heat to reduce the tightening (bronchoconstriction) of the airways in your lungs.

Your airways are surrounded by tiny bands of muscle that can tighten up (bronchoconstrict) and cause asthma symptoms. Bronchial thermoplasty reduces the amount of this muscle, which may help limit the bronchoconstriction.

Not all asthma patients are eligible for this procedure. Ask your healthcare providers if this is a treatment option for you.

Bronchial thermoplasty can only be done at a specialized healthcare centre by medical professionals with expertise in the procedure. Possible side effects should be explained to you by your healthcare provider.

 

Allergy treatments

Allergy shots and other forms of immunotherapy may help to reduce your reaction to certain allergens in your environment that you cannot avoid. Possible side effects should be explained to you by your healthcare provider.

Who will help me get my severe asthma under control?

Your healthcare provider will help you get your asthma under control. S/he make also:

  • Refer you to a lung specialist (respirologist and/or allergist) who will order various tests to assess your lungs (like lung function tests, X-rays), and prescribe the proper asthma treatment
  • Refer you to an allergist for an allergy assessment (like skin testing, blood tests), if allergies are suspected

You can also:

 

What can I do to ensure that my severe asthma treatment is successful?

You are a very important part of your asthma care team! You can work with your healthcare providers to achieve the best possible control of your asthma symptoms by:

  • Following your Asthma Action Plan;
  • Learning about all of your treatment options, so you can discuss them with your healthcare providers;
  • Learning how to recognize the signs and symptoms that your asthma is not under control (so that you can follow your Asthma Action Plan to get it back under control);
  • Using a daily asthma diary to track your daytime and nighttime symptoms, medication use, and exposure to triggers;
  • Telling your healthcare providers all of your medical concerns, whether they are asthma-related or not. Let them know of any side effects that you are experiencing from any of your treatments;
  • Making sure that your healthcare providers are treating all of your comorbidities; and
  • Visiting your healthcare providers on a regular basis (every three to six months) to reassess your overall health, level of asthma control, and asthma treatment plan

 

It is important not to “get used to” or “normalize” your asthma symptoms!