Article: Inhale, Exhale: The struggle of living with Severe Asthma and Severe Eosinophilic Asthma

Published in pharmaphorum

Head of “Living With”, Mariel Metcalfe, discusses the nature of severe asthma and severe eosinophilic asthma, and some key findings from recent studies conducted in Europe, USA and Japan. Published in pharmaphorum.

The science behind the condition
Most people know that asthma is a chronic long-term respiratory condition in which the lung’s airways become inflamed and narrowed, making it difficult for sufferers to breathe. It is also known that asthma causes wheezing and triggers a tightness in the chest. Medical researchers have identified that there are different types of asthma, and they respond differently to treatment. Severe asthma (SA) affects 15% of asthma suffers and usually appears in adults. Severe eosinophilic asthma (SEA) is rare and affects 40% of SA sufferers. 

Medicines typically prescribed to treat SA can be ineffective. Treatments including the normal preventer or reliever inhalers can fail to relieve symptoms, and a different targeted approach is often required to control patients’ symptoms in order to reduce the onset of asthma attacks. It is the most serious and life-threatening form of asthma and is extremely unpredictable, meaning someone living with SA can have more attacks, is more likely to stay in hospital and likely to be treated with long term oral corticosteroids. SA requires more aggressive treatment such as high-dose inhaled corticosteroids (ICS) in combination with a long-acting beta-agonist (LABA) or leukotriene modifier/theophylline in order to control symptoms.

Eosinophils are the major inflammatory cells which are considered a biomarker for asthma and eosinophilic inflammation correlates with asthma severity. In SEA, there are higher numbers of eosinophils (a type of white blood cell) in the blood, lung tissue and mucus meaning the whole respiratory tract suffers from airflow obstruction, which is why people with eosinophilic asthma frequently also suffer from nasal polyposis and chronic sinus disease. Patients with SEA can be put on a biologic drug to reduce inflammation in the airways, and there are a number of monoclonal antibody drugs currently available, with others in development.   

Severe or Eosinophilic? Impact on daily life
In a recent quantitative study conducted among people living with SA and SEA, we set out to understand the patient journey and unmet needs in order to help pharmaceutical companies improve the patient experience. The research was conducted with patients in France, Germany, Japan and the USA pre-COVID19 and all three reports are now available to purchase.

Interestingly, findings from the different regions reveal similarities and differences between SA and SEA. Both conditions equate to uncontrolled SA and patients experience symptoms despite treatment, which causes a major impact on both their home and working lives.

For someone to be diagnosed with SA they will usually have had asthma for a very long time and would have had to fail on multiple lines of treatment, such as inhaled corticosteroids, in order to get officially diagnosed with the more severe form. The patient journey is long, slow and troublesome, meaning most patients have become resigned to their condition and have allowed their asthma to take over, thus accepting not being able to do many day-to-day activities such as exercise.

The average SEA patient tends to be younger than SA patients, and has been diagnosed with their specific form of asthma earlier in their patient journey. A few years ago, a phenotype was identified to diagnose this specific form of severe asthma. This meant that these patients could be treated with a targeted biologic therapy. This treatment prospect appears to bring an increased level of hope to the SEA patient, who tends to have better access to healthcare and is more engaged and committed to seeking treatment to ensure they get a better quality of life. These patients also seem to be glad they have a name for their specific subtype of asthma, although some doctors seem to steer clear of the tricky medical term “eosinophilic” and may just call it “inflammation”.

Patients living with SA or SEA often describe the feeling of being trapped in a vicious cycle of anxiety about the onset of a potential attack, which can be extremely distressing and tiresome. In our research, one patient described the emotional burden as, “Very depressing. This disease is very changeable. When you have such a good day, the very next day is so bad. It feels like the disease comes to take you down.” Our research also revealed that the negative emotions in this cycle are especially high amongst SA patients, and whilst there are still high levels of stress for the SEA patient, in general they are glad that their condition has an identifiable name and more treatment options are available to them.

Regional differences show both SA and SEA patients across Europe and the US are generally committed to finding out about their disease and sourcing relevant information. However, in Japan, patients have a more paternalistic relationship with their doctor, and rely more solely on them for advice, rather than attempt to seek a broader understanding of their disease from other avenues.

How pharma can address the unmet needs
The three main unmet needs for both SA and EA patients center around informational, emotional and treatment needs.

Patients suffering with these extreme forms of asthma seem to want more information about treatments and management, and despite feeling more highly informed, SEA patients are still eager to learn about their disease. Having access to a variety of channels is important to patients so they can fill in disease education gaps which may have been left out by physicians. There is a great desire to receive information on specific websites, educational materials such as leaflets and brochures which contain lifestyle tips and material on how to cope with their condition, enabling the ability to break out of the stress cycle.

There is a clear unmet need for improved patient support programmes throughout the patient pathway. Emotional support is required, in particular from support groups, hotlines or apps.  Patients would like HCPs to be more empathetic about the condition and to help them get out of the stress cycle that exacerbates their condition. Furthermore, support to caregivers and family members is desired to help provide a stronger support network.

SEA patients are looking for new treatments that offer greater relief of everyday symptoms and reduced frequency of asthma attacks, coupled with good safety and ease and convenience of use. In the EU, needs focus more around convenience and frequency of administration. For SA, lower levels of control and limited improvement in quality of life means that SA patients are primarily looking for more efficacious treatments (both prevention and relief of attacks and symptoms).

SA and SEA are very specific forms of asthma which have only just recently been better understood and diagnosed. There are opportunities for pharma companies with treatments in development to offer additional hope to these patients, who suffer considerable discomfort in their daily lives. 

About the study: Living with Severe and Eosinophilic Asthma
Living with Severe and Eosinophilic Asthma is a new syndicated report which offers valuable insights into patient attitudes and behaviour. The EU study was conducted amongst 118 patients with diagnosis and/or confirmed characteristics of SA or SEA in France and Germany. The US study was conducted with 105 SA and SEA patients. For both studies the methodologies consisted of 30-minute quantitative online interviews and a small sample of 30-minute qualitative add-on telephone interviews. The Japan study consisted of 50 quantitative interviews with SA and SEA patients.

The reports enable pharmaceutical companies to gain an in-depth understanding of the patient journey, from diagnosis through to ongoing management and the key differences concerning living with SA compared to SEA. Through these reports, you will understand how these conditions impact patients’ lives physically and emotionally, what their level of understanding is about their condition and what unmet needs patients have related to its treatment and overall management of SA and SEA.