Concluding pt of 3 reviewing Asthma - this week - other treatment options
Posted by Eamonn Brady on
Asthma (Part 3)
Other treatment options
Leukotriene receptor antagonists (montelukast): an oral drug that acts by blocking part of the chemical reaction involved in inflammation of the airways. Montelukast is particularly beneficial for two types of asthma:
- asthma predominantly induced by exercise
- Asthma associated with allergic rhinitis.
Theophylline: helps widen the airways by relaxing the muscles around them. Theophylline is known to cause potential side effects, including headaches, nausea, insomnia, vomiting, irritability, and stomach upsets. These can usually be avoided by adjusting the dose. It has a narrow therapeutic index meaning the balance between sub-optimal dosage and overdosage is difficult to manage.
Biologics for severe Asthma
Biologics are a new class of drugs called monoclonal antibodies that are licenced for severe asthma. They reduce the inflammation from the in the respiratory tract. Only respiratory specialists can prescribe biologics.
Most biologics are given by subcutaneous injection once or twice a month. All biologics are an add-on option and do not replace existing reliever and preventer medication, but patients should eventually be able to reduce the dosage of existing therapies such as inhaled corticosteroids. Biologics are available to target the two subtypes of Type-2 Severe Asthma (i.e.) allergic (IgE-mediated) asthma and eosinophilic asthma
Biologic therapy drugs for severe asthma include:
- Omalizumab (Xolair®)
- Mepolizumab (Nucala®)
- Reslizumab (Cinqair®)
- Benralizumab (Fasenra®)
- Dupilumab (Dupixent®)
Of the 5 biologics listed above, Omalizumab is an anti-IgE agent, and the other 4 biologics are anti eosinophilic agents.
Biologics, are expensive (average cost is €15,000 per year), require frequent monitoring and limited to specific types of severe asthma meaning use is limited to strict protocols.
In clinical trials, all 5 biologics reduced annualised exacerbation rates by at least 50% and they all improved asthma symptom scores, lung function and quality of life and allowed reductions in maintenance oral corticosteroids while maintaining a favourable safety profile. Side effects of biologics include headache, pain, redness, itching, and/or a burning sensation at the injection site
Availability of Biologics for Asthma in Ireland
Biologics for asthma are paid directly out of hospital budgets which limits availability as hospitals only have limited budgets meaning respiratory consultants have to limit prescribing dependant on budget. The Asthma Society of Ireland is leading a campaign for the Government to allow greater patient access to biologics for asthma.
Booster Vaccine
Asthmatics are at more risk from COVID-19. Ask your doctor if you are eligible for the second Covid 19 booster. Whelehans Pharmacy Pearse St have a weekly walk-in clinic for Covid-19 boosters. Call 0449334591 for more info.
For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore). Email queries to info@whelehans.ie. Find us on Facebook.