Phenotype Testing Yields New Therapy Options for Steroid-Resistant Asthma

Improvements in diagnostic testing help pulmonologists

stethescope of image of lungs
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Biomarker analysis for patients with severe persistent or steroid-resistant asthma is being offered to individuals who experience frequent exacerbations or poorly controlled symptoms despite using standard-of-care inhaler-based therapies. Using in-clinic testing, Duke pulmonologists can identify disease phenotypes to develop individualized therapy plans for patients with poorly controlled asthma.

Improvements in diagnostic testing have given pulmonologists in Duke asthma clinics the ability to better characterize the underlying mechanism driving disease and exacerbation risk. Using a combination of standard and advanced pulmonary function tests, in addition to biomarker analysis, pulmonologists can define disease mechanisms more clearly to create a more precision-based treatment strategy, says Amber J. Oberle, MD, a Duke pulmonologist who specializes in asthma.

Recent advancements in asthma therapeutics have led to the development of several anti-eosinophilic biologic therapies available by prescription. These treatments have led to a substantial reduction in exacerbation risk and have allowed patients to substantially lower or even eliminate the need for oral corticosteroids.

This advancement in asthma care is critical, Oberle says, because long-term steroid use leads to adverse side effects such as weight gain, hypertension, elevated blood glucose levels, cataracts, osteoporosis, and increased susceptibility to infections.

Advancements in diagnostic testing have allowed pulmonologists in Duke asthma clinics the ability to better characterize the underlying mechanism driving the disease and exacerbation risk.  Using a combination of standard and advanced pulmonary function tests, in addition to biomarker analysis, Duke pulmonologists are better able to define disease mechanisms that allow for a more precision- based treatment strategy.

Fractional exhaled nitric oxide (FeNO) tests allow for point-of-care measurements of eosinophilic inflammation within the airways, Oberle says. This serves as an important adjunct to both blood eosinophil counts and serum immunoglobulin E testing. Patients with severe asthma may present with disproportionately high levels of inflammation in the airways, Oberle explains. By using a comprehensive diagnostic strategy, pulmonologists can identify patients who can benefit from individualized treatment plans.

“It’s an exciting time for all of us who work with patients with severe asthma,” says Oberle. “In past years, we only had prednisone as the key therapy for those patients with poorly controlled symptoms, but now the options are changing.”