番茄社区

In this exclusive 番茄社区 video, Njira Lugogo, MD, a pulmonologist at the University of Michigan in Ann Arbor, discusses some of the exciting developments that will shape the future of treating severe asthma, including targeted agents, making remission a goal of treatment, and the increased use of imaging.

Following is a transcript of her remarks:

When I look ahead to the future of severe asthma treatment, I'm frankly quite excited. And I think what we need to start thinking about is really tailoring therapies to our patients. And so at the bare minimum, we need to understand the patient's inflammatory phenotype -- checking eosinophils and nitric oxide levels -- and understanding if patients have allergic sensitization as well as their comorbidities. Now, the comorbidities could be both type 2 and non-type 2 comorbidities -- and really focusing on treatable traits and understanding globally how asthma is impacting our patients, targeting all these various things that are contributing to the patient's disease and improving that.

Secondarily, I'm excited about remission. So we are at the precipice of defining some new endpoints for our patients, and I feel like remission is one of those things that's aspirational, both for clinicians and for patients.

I like the idea of remission for a couple of reasons. One, it's a multifaceted outcome. It includes lung function changes, exacerbation reduction, oral corticosteroid sparing, plus/minus the presence of improvements in the utilization of background therapy, and of course asthma control measures. And it sort of highlights how treating asthma really requires you to think about all the different components that contribute to a patient's presentation and also to response.

And then the last thing I'm quite excited about is the idea that we are starting to veer into a more translational space with regards to imaging. And in the past, we really didn't do much imaging in asthma. We sort of felt like most of the imaging was normal, or perhaps you saw a little bit of bronchiectasis and maybe some mild air trapping, but we really didn't think those were clinically meaningful outcomes. But now we know that there's mucus plug scores that appear to have clinical implications in terms of lung function-declining exacerbations. They respond to treatments with our targeted therapies. We have computational measures that can tell us if people have small airway disease, air trapping, decreased lung volumes or increased lung volumes, and changes in resistance. And I think all of these things are really pushing us into the next frontier in terms of truly understanding what's happening on a patient level.

And lastly, we can share all this with our patients. People want to know what they might expect from treatment with severe asthma. We have a very robust pipeline of clinical trials with multiple new targeted therapies and novel interventions. So we just really need to close the gap between discovery and treating our patients, enabling them to have those outcomes that all of us would want.

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