Novel asthma therapy
DR. R. NARASIMHAN
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Newer forms of treatment for severe asthma help bring down the number of attacks.
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BRONCHIAL asthma is an inflammatory disease. The treatment has gone through various phases. Patients who are asthmatics know only too well how they used to run to doctors for that injection of adrenalin, which would open their air tubes and make them comfortable for some hours. All of them lived in a morbid fear of an attack of asthma that can be fatal and frustrating for patients, relatives and physicians.
Paradigm shift
There has been a paradigm shift from these injections to better modes of treatment in the form of inhalers. This has been possible due to better understanding of the pathogenesis of asthma.
The identification of steroid inhalers has been a boon to many asthmatics and has revolutionised the management of asthma, as it tackles the inflammation that is the hallmark of asthma. If only all asthmatics follow their doctor's advice, asthma control will be a reality.
But it is not as simple. We frequently encounter patients who have persistent asthma whose symptoms cannot be controlled despite steroid inhalers, tablets, bronchodialators. They need to get admitted many times in a year. In such cases, the optimum control cannot be achieved. These patients are prone to high risks of costs, hospital admissions and fatality rates. Taking care of these difficult asthmatics is becoming a challenge in optimum asthma control.
Allergic in nature
Research has shown that 80 per cent of asthma attacks are allergic in nature. The main factor in allergy is IgE antibody. If anything can be found to directly act on this antibody, patients will find some relief. There are two ways of achieving this. One is by identifying allergens by allergy tests and undergoing desensitisation treatment. Desensitisation consists of regular injections over two to three years so that the frequency is reduced. The need for hospitalisation can be brought down, as can the need for oral steroid tablets. The only disadvantage of this mode of therapy is injections for a long period, which is not relished by many patients. If one tests positive for too many allergens this exercise becomes futile.
New drug
Another way of tackling this IgE antibody is through injections. Recently Omalizumab, a drug that has been studied extensively in Europe and the U.S., has been introduced in the market. It is given as injections and acts directly against IgE antibody. It has been tried in 7,500 patients who were suffering with asthma, rhinitis or both. The safety, tolerability and side effects profile has been found satisfactory. This drug is expensive but is a useful adjunct to management in patients whose asthma is uncontrollable despite optimum compliance and best of medications.
Hyposensitisation against allergens and drugs against IgE antibody are considered to be novel and directed therapies against asthma. They will become popular as more people get to know about them.
The writer is a Senior Respiratory Physician, Apollo Hospitals, Chennai. E-mail: drrnarasimhan@gmail.com
Factfile
Allergy tests and hyposensitisation are useful only when one is allergic to one or two allergens.
Anti IgE antibody will not cure asthma but is an add-on drug that will help bring down the attacks.
It is useful only for severe cases whose asthma is not under control.
The physician has to decide with IgE levels.
Asthma is only a controllable disease and not curable.
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