Some of the 24 million people in the U.S. with asthma, or inflammation that narrows the airways, suffer severe symptoms: Like persistent shortness of breath. The inability to speak in full sentences. Or a chest that feels closed. Two new studies tout possible new treatments for severe asthma.
Highlights from the interview with Dr. Joseph Austin, a pulmonologist with Texas Health Arlington Memorial Hospital:
One study indicates oral supplements of vitamin D may help with severe asthma: “The claim is that it reduces inflammation As a result, patients with asthma or potential for other infectious diseases are reduced. The overall thinking is that the vitamin D is the “new drug” and it’s being tested for various things and one of them is chronic inflammation. The overall consensus is that it probably doesn’t have the effect that some people actually say it does.”
You can get vitamin-d from food sources, the sun. Would more of either work or does it have to be an oral supplement? “Kind of interesting because it’s a fat soluble vitamin that stores in the body in various concentrations. Most of the research on it centers around a disease known as rickets, which we don’t see much of in our country. It is present in some of the Third World countries where they don’t have milk products and other types of food that would be rich in vitamin-D. There is also the principle that sun exposure does help the metabolism of vitamin-D. It helps you produce it. And if you’re in an environment where there’s a lot of sun, then you probably don’t have a deficiency of vitamin-D, even if you only get small amounts in your diet.”
Two trials conclude injections of benralizumab shows promise: “What you have there is a drug that adheres to a protein in the body that limits the inflammatory reaction. It’s not approved yet in our country and is undergoing phase three research.”
And how exactly would this work? “It’s only for patients with rare forms of asthma. A lot of research involves a cell called eosinophil. The eosinophils have globulin in there that when the cell ruptures, the globules stimulate am inflammatory reaction. In stimulating that reaction, we have lining surface cell changes, as well as stimulation of the circular muscles that surround the airwaves themselves. So when those circular muscles contract, we have tightening of the airway, and the airflow through those bronchial tubes becomes limited and that’s why patients begin to have shortness of breath. And it’s the patients that have a high population of eosinophils that this medicine works best against. It’s a medicine that works for up to three months after you receive an injection from it, so it’s very promising, but it’s not first-line therapy.”
In both cases, are people trying to come up with something to reduce inflammation? “Yes, because I think there is a global market for asthmatic patients. And even though less than one percent have severe asthma, at least 25 to 30 percent actually have levels of eosinophils. So if we’re able to block it, that is a treatment modality for them.”
Are there effective treatments for them now? “Yes. That’s why this particular drug is of interest, because those patients that have severe asthma do not respond well to the standard treatment as it exists. Some of the medicine that we give them now are medicines designed to relax the smooth muscle, it does that. There are other medicines designed to reduce inflammation in the airway and mucus secretion, but sometimes that’s not enough.”