World Asthma Day is an annual event organized by the Global Initiative for Asthma (GINA) to raise awareness of asthma worldwide. In 2023, the theme chosen by GINA is “Asthma Care for All”.
Asthma is broadly defined as reversible airflow obstruction characterised by bronchial hyper-responsiveness to otherwise innocuous triggers. It is a heterogeneous pulmonary disease with complex aetiology affecting approximately 250-300 million people worldwide with increasing tendency. Asthmatic pathology is characterised by the overproduction of mucus by goblet cells, thickening of hypercontractile airway smooth muscle cell layers and inflammation of the lungs, all contributing to a pathological narrowing of airways and airflow obstruction. The symptoms of asthma include cough, shortness of breath, and wheezing.
Asthma is no longer considered as a single disease but categorized into different types, including allergic asthma, exercise-induced asthma, occupational asthma or steroid-resistant asthma each requiring different management strategies.
While there is no cure for asthma, tremendous progress has been made in the management of the disease, enabling patients to live a life with little or no restrictions. Treatment typically involves the use of inhaled medications to reduce inflammation and open up the airways. In addition to medication, it is important for people with asthma to identify and avoid their triggers as much as possible.
Some common medications for asthma include short-acting beta-2-agonists (SABA’s) such as Albuterol and Terbutaline for quick relief of symptoms, inhaled steroids such as Fluticasone and Budesonide for reducing airway inflammation, long-acting beta-2-agonists (LABA’s) such as Formoterol and Salmeterol for dilation of airways, and leukotriene-modifying agents such as Zafirlukast and Zileuton for both dilation of airways and reducing inflammation.
While these treatments are mostly effective in controlling symptoms of asthma, they provide no cure and some patients develop severe steroid-resistant asthma. The underlying cause for the development of asthma is incompletely understood but due to extensive research cell types and their mediators, causing disease pathology are well known. Hence, new types of antibody-based drugs have been developed that target specific disease mediators.
In 2003, Omalizumab, a humanized monoclonal anti-IgE antibody was the first monoclonal antibody approved by the FDA for the treatment of asthma. Since then, several monoclonal antibody therapies got approved for the treatment of asthma. Notably, these drugs all target the Th2-type immune response often associated with allergic or eosinophilic asthma. Mepolizumab, Reslizumab and Benralizumab target the interleukin-5 signalling, a cytokine involved in eosinophilic inflammation. Dupilumab is a human Ig4 monoclonal antibody directed against the interleukin-4 receptor subunit α (IL-4Rα) of IL-4 and IL-13 receptors, inhibiting signalling of both IL-4 and IL-13 two key players in type 2 inflammation. These biological drugs have been successfully adopted into clinical practice as add-on therapies to inhaled corticosteroids mostly in patients with persistent severe steroid-refractory allergic asthma.
Despite these impressive advancements in the treatment and management of asthma, one major issue remains – most of the burden of asthma morbidity and mortality occurs in low and middle-income countries. The aim must be to reduce this burden by ensuring that effective treatments become available to all patients in need of high-quality medications. The “Asthma Care for All” message of the 2023 World Asthma Day promotes this aim.
Synexa Life Sciences, with our roots in South Africa, fully supports the goal of making treatment more accessible. We have extensive experience and expertise in bioanalytical assays for biologicals and biosimilars.
Get in touch if you want to find out more about how Synexa can support new drug development programs.
Written by Dr. Frank Kirstein, Scientific Consultant
Sources:
- https://ginasthma.org/2023-world-asthma-day/
- https://www.who.int/news-room/fact-sheets/detail/asthma
- http://globalasthmareport.org/index.html
- 2022 GINA Report, Global Strategy for Asthma Management and Prevention
- 2022 Front. Immunol. 13:983852. Monoclonal antibodies in the management of asthma: Dead ends, current status and future perspectives;
