For a physician the hardest job is to figure out severe asthma : Prof. Felix Herth

Today we have a much better understanding of different phenotypes of asthma. In future, patients will be getting more and more insight into molecular changing, the pathways of the different phenotypes and then the industry will provide us with more and more biologicals.

Shahid Akhter | ETHealthWorld
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Shahid Akhter, editor, ETHealthworld spoke to Prof. Felix Herth, Thoraxklinik, University of Heidelberg, Germany, to know more about the severity of asthma and the success of bronchial thermoplasty. Edited excerpts:

How good is our understanding and success rate of Bronchial thermoplasty ?
We have a huge severe asthma program running in Europe, so that’s why I have a little bit of understanding about the issue.

As of now, good quality evidence is lacking for recommending Bronchial thermoplasty in the routine management of bronchial asthma. Also, possibly because the therapy is fairly recent. Do you believe this will change the near future? Is there enough success being witnessed from this therapy?
In Europe and also the U.S several randomized control trials have shown that there is enough evidence in the use of thermoplasty in a very selective severe asthma patient. And we were able to show that we can improve the quality of life. We can reduce the excarbation numbers of those patients treated with thermoplasty. So, therefore, in the U.S. the FDA and also in Europe the EMEA approved the technology. The debate is little bit about the cost of the procedure, if you have to go through three bronchoscopies, you need three catheters and you have to pay for the catheters. Therefore, the evidence is there it’s a little bit more the money and this is the issue where we have to work on.

What kind of co-morbidities are associated with severe asthma ?
I think the co morbidities in severe asthma, they are similar where ever you are. It’s obesity and there is also rhinitis. And, also we have a lot of asthma patients smoking little bit also. COPD can be a co-morbidity which is appearing in those asthma patients. So, at the end of the day for all treating physicians they really have to look to different co-morbirdities to really have in focus what is asthma-related regarding the symptoms and what is co-morbidity related regarding the symptoms the patients complaining off.

What is the role of Biologics in severe asthma management ?
We have nowadays a better understanding about different phenotypes of asthma. We have an eosinophilic phenotype, you can measure the blood rate of eosinophils and we also have an elevated IGE sub type and those patients can also be treated. Their quality of life can be significantly improved. For a small bunch of severe asthma patients, we have biologics and they really help those patients.

What are some of the best global practices in the management of severe asthma ?
I think the most important point is to figure out if the patient is really suffering from severe asthma because some patients are not adherent to the inhalers and complaining of symptoms. This is not a severe asthma patient, this is the patient who is not adhering to the therapy. Some patients have vocal cord dysfunction, mimicking severe asthma. So, for you as a treating physician the hardest job is to figure out if the patient really suffers from severe asthma. For those when you figure out this is the patient then you have to do the phenotyping and then you can do the phenotype specific therapy, but the issue is if the patient is really severe.

What according to you is the future of Severe Asthma Management ?
The future of for all of our patients will be getting more and more insight into molecular changing, the pathways of the different phenotypes and then the industry will provide us with more and more biologicals. So, in the future we will have a bunch of biologics for very specified patients, so we can treat the patients in a better way. The backside of the coin is that, it will be very expensive for our health system. So, the question is ‘who will be able to pay for all those expensive therapies’ but it is something we have to look on as a community.

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