(Focus - Singapore)
We had a discussion on Asthma with Dr. Sridhar Venkateswaran, a renowned Senior Consultant in the Division of Respiratory Medicine at Ng Teng Fong General Hospital, Singapore.
Dr. Sridhar mentioned that temperature swings are common for causing asthma flares. With awareness and proper care, it is possible to get relief from asthma.
Biologics are not used as an upfront option. It is probably an add-on option if Asthma is not fully controlled or not controlled despite use of maximal anti-asthma therapies, such as combination inhalers. They would also be considered only if there is a need to use continuous oral corticosteroids in the long term.
What is the burden of Asthma in Singapore, and can you briefly describe the standard of care followed?
Dr. Sridhar: I am an adult respiratory physician, and therefore I do not treat children. If we talk about adults, the burden of Asthma is in the range of about 5% in terms of prevalence. We see people with Asthma regularly, both inpatient and outpatient, and our treatment is in line with the guidelines.
What are the unmet needs in the treatment and management of asthma patients in Singapore?
Dr. Sridhar: One of the unmet needs could be a lack of education among those less well educated and who might not understand the disease. The second unmet need could be the affordability of certain inhalers, especially the newer inhalers.
We have several biologics (e.g., omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab) available for the treatment of Asthma.
Biologics are not used as an upfront option. It is probably an add-on option if Asthma is not
fully controlled or not controlled despite use of maximal anti-asthma therapies, such as combination inhalers. They would also be considered only if there is a need to use continuous oral corticosteroids in the long term.
How can biologics help severe asthma patients as compared to conventional treatments?
Dr. Sridhar: Biologics:
· Can reduce the frequency of exacerbations in the hospital.
· Reduces the severity of symptoms, even if they are not admitted.
· Can reduce the steroid burden, especially the systemic or oral corticosteroid burden, which causes many long-term side effects.
What are the new therapies in development for the treatment of Asthma?
Dr. Sridhar: New therapies have not yet reached the clinical market. Many new biologics and new molecules are being developed, which affect different inflammatory cascades, but none are available for clinical use.
Are they in a clinical trial doctor?
Dr. Sridhar: Many clinical trials are going on worldwide, but I am not involved in any of the clinical trials.
The main message to patients is that Asthma is a lifelong chronic disease. Most patients require lifelong treatment with inhaled corticosteroids. Of course, with the treatment, they should be able to live a normal everyday healthy lifestyle.
What challenges did you face in asthma management during the COVID-19 pandemic?
Dr. Sridhar: One of the good things about the pandemic was that it did not cause any worsening of Asthma compared to the pre-pandemic era. Even though patients had exacerbations, we were able to treat them as per normal guidelines.
If at all, the challenges were, that did get sicker, especially those who came to the hospital with pneumonia. We had to manage COVID pneumonia and treat them with specific antivirals in addition to the steroids. Since many of the moderate-severe COVID patients needed steroids, it was beneficial in treating their Asthma as well.
A study by Oxford University found that inhaled corticosteroids (e.g., budesonide) can reduce the recovery time for people not hospitalized with coronavirus by three days.
What is your experience with inhaled corticosteroids for asthma patients affected by COVID-19? 1
Dr. Sridhar: People in step two or three of GINA (Global Initiative for Asthma) will always be on long-term inhaled corticosteroids. There will never be asthmatics without inhaled corticosteroids except perhaps in GINA step one, which is very mild persistent Asthma or patients with occasional asthma symptoms. So, it is challenging to say whether inhaled corticosteroids affect hospital admissions or hospitalizations.
Asthma patients on inhaled corticosteroids have had exacerbations due to COVID, but most have not. So, anecdotally, it may offer some protection because most patients would have been on inhaled corticosteroids in some form or the other, but no specific can be recommendation can be made as of now.
Before we conclude, what are your takeaway messages to asthma patients and their caregivers?
Dr. Sridhar: The main message to patients is that Asthma is a lifelong chronic disease. Most patients require lifelong treatment with inhaled corticosteroids. Of course, with the treatment, they should be able to live a normal everyday healthy lifestyle.
Thank you so much, Dr. Sridhar, for sharing your insights on Asthma!