Dr. Paul O’Byrne discusses strategies to prevent and treat asthma flare-ups (also known as exacerbations or asthma attacks). Dr. O’Byrne is Chair of the Department of Medicine at McMaster University in Hamilton, Ontario, Canada and a member of the GINA Board of Directors and GINA Science Committee.
My name is paula byrne and i work at mcmaster university which is in hamilton in ontario and canada i want to speak about asthma exacerbations and the best way to reduce their risk to patients with persistent asthma asthma exacerbations are a time of great risk to patients with asthma as that is the time when patients are suffering the greatest morbidity from the
Disease or at the greatest risk of a severe on toward event and it’s also the time of greatest stress to patients and their family as well as the time of greatest economic effect both on the patient and on the healthcare system because of patients having to miss work or school and having patients managed often in an in hospital setting it’s for these reasons that
The gena guideline a newly revised this year as well as all other browser management guidelines focused on reducing severe risk of exacerbations as a very important component of a management plan for patients without we know a lot about the ways to reduce risk of exacerbations in patients with asthma and of the treatments that we have available by far the most
Effective are inhaled corticosteroids even low doses will reduce asthma exacerbation risk in patients by at least 50% or however patients who are taking their inhaled steroids but still have exacerbations and the evidence is now very compelling that adding and inhaled long-acting beta 2 agonist to the inhaled steroids and having these delivered from a single and
Hillier further reduces exacerbation risk in patients by about another 50% on top of the effect of hale’s steroids alone and so the combination of ics and lava treatment not only improves asthma symptoms but also has this great benefit in reducing exacerbation risk in patients who are requiring combination treatment with ics and labas it is also possible to get a
Further benefit in reducing risk at exacerbations when a combination that has an ics +4 motor role as the lava is used both as a maintenance treatment and a rescue treatment and in patients who are prone to exacerbations or who have had exacerbations in the previous year this benefit of treating with the ics lava combination as maintenance and rescue is now also
Recognized as being useful in the new iteration of the jeana ozma management guideline now even with these effective treatments there are still some patients perhaps 5 or 10 percent of all patients with asthma who are still poorly controlled and the more poorly controlled asthma is the greater the risk of a severe exacerbation is and so treatments that we would
Add to ics laba should also have some benefit at reducing exacerbation risk and this has been demonstrated for example for all corticosteroids in patients who have persisting airway s and a philia it’s also been demonstrated for the use of the anti jeje monoclonal antibody or meliza mab and there is even data in children that adding montelukast can have a small
But clinically useful benefit in reducing risk of severe asthma exacerbations it will also be very important for all therapies that are being developed as new treatments for severe asthma not well managed with current therapies that they do have this additional benefit in reducing this risk to patients on all the treatments that we have are extremely effective
And for those small group of patients not well managed on current therapy there are additional treatment options that will have benefit in reducing risk to patients you
Transcribed from video
Dr. Paul O'Byrne (GINA Science Committee) on Asthma Flare-Ups By Global Initiative for Asthma