Clinical Issues in Severe Asthma

Faculty

Reynold Panettieri, Jr, MD
Professor of Medicine
Robert Wood Johnson Medical School
Vice Chancellor, Translational Medicine of Science
Director, Rutgers Institute for Translational Medicine and Science
New Brunswick, New Jersey
Emeritus Professor of Medicine
University of Pennsylvania
Philadelphia, Pennsylvania

Michael Wechsler, MD, MMSc
Professor, Department of Medicine
Co-Director, The Cohen Family Asthma Institute
Division of Pulmonary, Critical Care and Sleep Medicine
Director, Asthma Program
National Jewish Health
Denver, Colorado

Sally E. Wenzel, MD
Professor of Medicine and Immunology
Director, University of Pittsburgh Asthma Institute at UPMC/UPSOM
UPMC Chair of Translational Airway Biology
Chair, Department of Environmental and Occupational Health
Graduate School of Public Health
University of Pittsburgh
Pittsburgh, Pennsylvania

Course Description

An outsized proportion of asthma-related morbidity and mortality is borne by the 5% to 15% of affected patients who have severe forms of the disease.^1,2 These patients suffer from poorly controlled symptoms and frequent exacerbations, often despite daily treatment with high-dose inhaled corticosteroids and other long-acting controller medications.^1,2 Ongoing research has elucidated key pathophysiologic processes and other clinical parameters related to asthma severity and persistence.^2,3 In many cases, the patient’s medical history, clinical presentation, and results from biomarker testing can help classify severe asthma phenotypically.^2,3 Increasingly, this can allow physicians to personalize maintenance regimens using targeted therapies that reflect identified endotypes—ie, asthma phenotypes linked to specific underlying disease mechanisms and proinflammatory signaling cascades.^2,4,5 Several biologic medications are now available to treat certain cohorts with severe asthma, and a number of other targeted agents are in late-stage development.^5-7 Pulmonologists and other asthma specialists who manage patients with severe asthma need to stay current on the latest published trial data for newer targeted therapies, approvals from the US Food and Drug Administration, and actionable best-practice recommendations on evaluating and treating patients with severe asthma. During this web-based Clinical Issues™ program, a panel of expert faculty will discuss and debate a series of topics related to comprehensively evaluating and longitudinally managing patients with severe asthma, including how the evolving evidence base should shape clinical decision-making and implications of new study data presented at the 2018 American Thoracic Society International Conference.

References

1. Levy ML. The national review of asthma deaths: what did we learn and what needs to change? Breathe (Sheff). 2015;11(1):14-24.
2. Chung KF, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43(2):343-373.
3. Wan XC, Woodruff PG. Biomarkers in severe asthma. Immunol Allergy Clin North Am. 2016;36(3):547-557.
4. Lötvall J, et al. Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome. J Allergy Clin Immunol. 2011;127(2):355-360.
5. Fajt ML, Wenzel SE. Asthma phenotypes and the use of biologic medications in asthma and allergic disease: the next steps toward personalized care. J Allergy Clin Immunol. 2015;135(2):299-310.
6. Bousquet J, et al. Care pathways for the selection of a biologic in severe asthma. Eur Respir J. 2017;50(6):1701782.
7. Walsh GM. Biologics targeting IL-5, IL-4 or IL-13 for the treatment of asthma—an update. Expert Rev Clin Immunol. 2017;13(2):143-149.

Target Audience

This activity has been designed to addresses the needs of allergists/clinical immunologists, pulmonologists, and other clinicians involved in the management of patients with severe asthma.

Educational Objectives

Upon completion of this activity, participants will be better able to do the following:

• Discuss severe asthma heterogeneity and disease biomarkers with a focus on Th2 cell–mediated pathophysiologic mechanisms
• Evaluate patients with severe asthma for symptom severity, exacerbation history, comorbidities, disease phenotypes, and prior treatment responses
• Differentiate the clinical profiles of current and emerging biologic medications for patients with severe asthma
• Individualize therapeutic regimens for patients with severe asthma based on disease phenotypes, ongoing assessment of symptoms, exacerbation risks, and comorbid conditions

Disclosure of Conflicts of Interest

It is the policy of the Elsevier Office of Continuing Medical Education that all faculty, instructors, and planners disclose any real or apparent conflicts of interest relating to the topics of this educational activity.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

Reynold A. Panettieri, Jr, MD: Speakers Bureau: AstraZeneca; Boehringer-Ingelheim; Boston Scientific Corporation; MedImmune, LLC; Novartis Pharmaceuticals Corporation; Teva Pharmaceutical Industries Ltd. Consultant/Advisor: AstraZeneca; MedImmune, LLC; Novartis Pharmaceuticals Corporation. Research Grant: Amgen Inc.; AstraZeneca; Bristol-Myers Squibb Company; Genentech, Inc.; Gilead Sciences, Inc.; MedImmune, LLC; Novartis Pharmaceuticals Corporation; OncoArendi Therapeutics SA; RFIM; sanofi-aventis U.S. LLC; Theratrophix, LLC; Vertex Pharmaceuticals Incorporated.

Michael E. Wechsler, MD, MMSc: Consultant/Advisor: AstraZeneca; Boehringer-Ingelheim; GlaxoSmithKline; Novartis Pharmaceuticals Corporation; Regeneron Pharmaceuticals, Inc.; sanofi-aventis U.S. LLC; Teva Pharmaceutical Industries Ltd.

Sally E. Wenzel, MD: Consultant, advisor: AstraZeneca; Merck & Co., Inc.; sanofi-aventis U.S. LLC. Research Grant: AstraZeneca; Boehringer-Ingelheim; GlaxoSmithKline; Novartis Pharmaceuticals Corporation; sanofi-aventis U.S. LLC

Non-faculty

Rose O’Connor, PhD, CHCP; Jim Kappler, PhD; Sandy Breslow; Alison Kemp; and Bernard M. Abrams, MD, hereby state that neither they nor their spouses/life partners have had any financial relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

CME Credit (Physicians) 

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Elsevier Office of Continuing Medical Education and Integritas Communications. The Elsevier Office of Continuing Medical Education is accredited by the ACCME to provide continuing medical education for physicians.

The Elsevier Office of Continuing Medical Education designates this enduring activity for a maximum of 1.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CME Inquiries/Special Needs

For all CME inquiries or special needs, please contact elsevierCME@elsevier.com.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. The Elsevier Office of Continuing Medical Education, Integritas Communications, and Sanofi Genzyme and Regeneron Pharmaceuticals do not recommend the use of any agent outside of the labeled indications.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Method of Participation

In order to claim credit, participants must complete the following:

1. Read the educational objectives, accreditation information, and faculty disclosures at the beginning of this activity.
2. Complete the Pre-Activity Questions.
3. Read or review the activity content.
4. Complete the Post-Activity Test Questions and Evaluation.
5. Physicians who receive a grade of 70% or better on the Post-Activity Test and who complete the Evaluation will receive a CME Certificate.
6. All other participants who receive a grade of 70% or better on the Post-Activity Test and who complete the Evaluation will receive a Certificate of Participation.