One of the most frequently asked questions among asthma patients is can asthma go away. About 235 million people worldwide are affected by asthma, making it the second largest cause of death, followed by COPD. It is a chronic and non-communicable disease that may result in persistent respiratory symptoms, including shortness of breath, cough, and chest tightness. Limiting airflow may lead to bronchoconstriction, a condition wherein the airway wall is thickened, making it difficult for the person to breathe.
As the disease becomes one of the highest global health burdens, it becomes essential to understand the pathophysiology of the disease. It presents itself complexly, involving different host-environment interactions occurring at multiple scales, from genes to organs.
Throughout these years, the treatment of asthma has changed its face and fate completely. The question that arises now is whether asthma can be cured forever. The management now is more control-based, involving an iterative cycle of assessment and response review. This means understanding the symptoms and risk factors to choose between the most suitable treatment options (pharmacological or non-pharmacological) leading to a direct response to the symptoms and side effects. However, quite recently, scientists have claimed that they have found a permanent cure for asthma.
In this article, we shall break down the myth of the invention of a permanent cure for asthma and where we are with it now.
In this article
Can asthma go away forever?
The currently available medications for asthma reduce airway inflammation and prevent the symptoms. These drug categories include inhaled corticosteroids and short-acting beta-agonists.https://emedicine.medscape.com/article/296301-medication These two molecular drugs act by relieving symptoms and reducing airway bronchoconstriction, respectively.
However, the national and international guidelines from the Global Initiative for Asthma (GINA) have recommended SABAs as the first-line treatment for asthma, even for mild cases. These medicines are also used for rapid symptom relief. Some of the asthma symptoms include breathlessness, tight chest, and more. This approach stems from the dated idea that the symptoms of the disease are related to smooth muscle contradiction rather than a condition caused by inflammation.
In 2019, these guidelines introduced substantial changes, overcoming some limitations of the previously suggested stepwise approach to asthma treatment for individual patients. The anti-inflammatory reliever has been adopted at all degrees of severity as a crucial component in managing asthma. Thereby increasing the efficacy of the treatment while lowering SABA risks associated with patients’ tendency to rely on or over-rely on the as-needed medication.
Until 2017, asthma treatment relied on a controller medication as the primary treatment, with SABAs used only as a last resort. This left milder asthma patients without anti-inflammatory treatment, relying solely on SABA rescue medication.
Also, the traditional approach to treating asthma ran into a common hurdle – patients often skipped their regular controller medications, leading to overreliance on rescue medication. This pattern has been attributed to patients only taking medicine when they feel symptoms and avoiding it when they feel fine. This behavior can lead to increased use of SABAs, which may have negative health consequences. In fact, studies suggest that overusing beta-agonists alone can increase the risk of death from asthma.
To keep asthma under control, low-dose ICS is highly effective in treating mild persistent disease. But if more is needed, the first choice is to add LABA maintenance and as-needed SABA. Another option is to use a single treatment that combines low-dose ICS/LABA (formoterol) – also known as SMART. This approach has been backed by robust clinical evidence and is recommended across GINA Steps 3 to 5. With the SMART strategy, the rapid-acting formoterol helps control asthma symptoms.
According to a one-year study called FACET, adding an LABA to ICS treatment can lower severe and mild asthma exacerbation rates. This study focused on patients with persistent asthma symptoms despite receiving ICS. The study found that adding formoterol to two dose levels of budesonide (100 and 400 µg bid) reduced the incidence of severe and mild asthma exacerbations, regardless of the ICS dose. Specifically, this addition reduced severe and mild exacerbation rates by 26% and 40%, respectively, while if done in higher amounts, reduced these rates by 63% and 62%, respectively.
What are the current challenges in asthma pharmacotherapy?
Despite the attempt to improve the treatment of severe asthma, several unmet needs in this population remain, motivating research to identify novel targets and develop improved therapeutic and/or preventative asthma treatments. The current conventional ‘one-size-fits-all’ approach to asthma management is also being re-evaluated for more precise asthma management.
Over the years, the pharmacological treatment of asthma has faced several barriers and controversies, leading to ineffective disease management. One of the controversies, as described by O’Byrne and colleagues, is the recommendation of SABA bronchodilator use alone in Step 1 of earlier guidelines, despite asthma being a chronic inflammatory condition. Additionally, the autonomy given to patients over the perception of need and disease control at Step 1 has been a concern, as opposed to the recommendation of a fixed-dose approach with the treatment-step increase, regardless of the level of symptoms.
Other controversies outlined include patients’ difficulty in understanding the recommendation to minimize SABA use at Step 2 and switch to a fixed-dose ICS regimen when they perceive SABA use as more effective, the conflicting safety messages within the guidelines regarding patient-administered SABA monotherapy being safe but patient-administered LABA monotherapy being not, and the discrepancy in patients’ understanding of “controlled asthma” and their symptom frequency, impact, and severity.
Here is a snippet of milestones of asthma therapy in the last 20 years.
These controversies can lead to an over-dependence on SABAs, with asthma patients freely using (and possibly overusing) SABAs as rescue medication. Studies have shown that SABA overuse or overreliance may be linked to asthma-related deaths, with the number of SABA canisters used per year directly related to the risk of death in patients with asthma.
On the other hand, low-dose ICS used regularly are associated with a decreased risk of asthma death, with discontinuing these agents possibly detrimental. Another barrier to pharmacotherapy is the suggestion that prolonged treatment with LABAs may mask airway inflammation or promote tolerance to their effects. However, studies have found that adding regular treatment with formoterol to budesonide for 12 months did not decrease asthma control and improved asthma symptoms and lung function in patients with persistent asthma symptoms despite taking inhaled glucocorticoids.
How can personalized medicine enhance the treatment of asthma?
Identifying ‘treatable traits’ that contribute to respiratory symptoms in individual patients with asthma may allow a more pragmatic approach to establish more personalized therapeutic goals. This means customized medicine can help identify specific factors contributing to a patient’s asthma symptoms and tailor treatment rather than using a one-size-fits-all approach. This approach could lead to more effective and efficient treatment of the disease.
Asthma cure strategies across all levels of severity
There are several controversies surrounding the pharmacotherapy of asthma, such as an over-reliance on SABAs and conflicting safety messaging. Research has demonstrated a link between SABA overuse and asthma-related fatalities, whereas low-dose ICS has been shown to decrease the risk of death. Combining budesonide with regular formoterol treatment can also improve asthma symptoms. Ultimately, successful asthma management necessitates addressing these contentious issues.
In conclusion, we know about asthma and the lungs more than we ever knew in the history of mankind. However, there are still some pieces of the puzzle to unfold. Uncovering these pieces might bring us to a permanent cure for asthma in the coming future, but as of today, it’s only the best management techniques that healthcare can offer patients.
