Asthma is a heterogeneous chronic inflammatory disease of the airways, characterised by episodic expiratory airflow limitation due to bronchial smooth muscle constriction and airway inflammation (1). Frequent exacerbations requiring oral corticosteroids are a predominant feature in patients with severe asthma. Patients with frequents exacerbations have high rates of health care utilisation and loss of productivity, the two primary drivers in asthma cost (2). Approved targeted biologic therapy for severe eosinophilic asthma includes omalizumab targeting IgE, mepolizumab and reslizumab targeting IL-5, benralizumab targeting the IL-5R and dupilumab targeting IL-4R. These expensive therapies have been shown to reduce exacerbation rates, reduce the daily dose of oral corticosteroids, improve asthma control, quality of life and lung function. For a patient to be deemed eligible for biologic therapy, confirmation of asthma diagnosis, adherence monitoring, stepwise escalation of their maintenance therapy, treatment of co-morbid disease is critical. In Mayo University hospital (MUH), inhaler adherence is assessed by electronic monitoring, monitoring of fractional exhaled nitric oxide (FeNO), and confirmation of pharmacy prescription records prior to commencement of biologic therapy. In addition, patients are monitored monthly for three , to assess their asthma control, exacerbation rate, and to monitor airway inflammatory profile.
The aim of this study is to evaluate clinical response of patients with severe asthma treated with either Omalizumab or Mepolizumab/ Benralizumab in MUH.
Methodology
This will be a retrospective study of severe asthma patients commence on either anti-IGE therapy or anti-IL5 therapy from the 1st January 2020 till 30th of June 2023.Data will be collected for a period of 12 pre and post commencement of biologic therapy to assess clinical response. Outcomes that will be assessed include exacerbation history, asthma control test (ACT) questionnaire, blood eosinophils, FeNO, PEFR, asthma quality of life and pharmacological treatment for asthma.
