SPECIALISED TREATMENT FOR PEOPLE WITH SEVERE ASTHMA 

People with diagnosed severe asthma experience great burden from their disease due to persistent and often severe symptoms;, they often need to regularly use oral steroid medicine on top of high doses of inhaled medicines, and they face significant interruption to their lives. Advances in the discovery of new medicines which can be effective at reducing this burden are much needed by people with severe asthma. 

The Australian Pharmaceutical Benefits Scheme (PBS) has recently listed a specialised treatment for use by people with severe asthma. It’s called Dupixent and contains Dupilumab, a monoclonal antibody, which targets the pathways that leads to the symptoms of severe asthma. 

Asthma Australia would like to update you on this new treatment for severe asthma so you’re informed and empowered to know your options and make the best choices for you and your family. 

WHAT IS SEVERE ASTHMA? 

Severe asthma is a specific ‘classification’ of asthma: it and is asthma that remains uncontrolled despite treatable factors having been addressed, and maximal inhaled therapy being taken regularly. It is estimated that 3-8% of all people with asthma have severe asthma. 

A severe asthma diagnosis is different from severe asthma ‘attack’ or ‘flare-up’.  

HOW IS SEVERE ASTHMA TREATED? 

The goals of treatment in severe asthma are to improve asthma control, reduce the burden of symptoms and the risk of asthma flare-ups, preserve the health of the lungs and reduce side effects of treatment. People with severe asthma will also have their own goals.  

Preventers 

The main goal of treatment in asthma is to obtain control and prevent ‘asthma attacks’ or ‘flare-ups’. The most important treatment, therefore, is a medicine that prevents these from occurring. Preventers are used to reduce the inflammation and sensitivity in the airways, which in turn prevents symptoms and reduces the risk of flare-ups. This is effective for most people with asthma. Preventers are inhaled, so they work inside the airways, where they need to. 

Combination preventers 

Some inhaled preventers come in combination form, and they are called combination preventer inhalers. They contain both the preventer and reliever types of medications and they work by both reducing the inflammation in the airways and relaxing the tight airway muscles. Combination preventers are prescribed for daily or twice daily inhalation and must be used in this way to be effective.  

Relievers 

The other part of medical treatment in asthma involves the use of a bronchodilator (to open and relax the breathing tubes), which aims to relax the muscles in the airways. Commonly known as relievers or dual-purpose relievers, these medicines are also inhaled and provide quick relief of symptoms. Relievers are used alongside preventers to treat symptoms that breakthrough despite tailored preventer treatment. 

Add-on treatments 

Add-on treatments in asthma are medicines that are added into a person’s daily preventer regime when asthma symptoms persist despite the correct use of tailored preventer therapy. There are a number of add-on treatments available in asthma and they work in different ways. Some work by reducing the cause of airway inflammation and others work by relaxing airway muscles.   

Monoclonal antibodies 

This is where Dupixent (dupilumab) fits. People with severe asthma require regular daily moderate to high doses of inhaled preventer and add-on medication tailored to their individual needs. They also require support to address the factors that contribute to their asthma symptoms.  

However, when:  

  • Inhaled treatment is used regularly, as prescribed, correctly and in optimal doses, and;  
  • All treatable factors have been addressed, and;  
  • A person continues to experience symptoms and flare-ups: 

Specialised treatment in the form of monoclonal antibodies (otherwise known as ‘biologics’) is recommended. Monoclonal antibodies can only be prescribed by a specialist doctor and only according to strict criteria.  

 

WHAT IS DUPIXENT (dupilumab)? 

Dupixent (dupilumab) is a monoclonal antibody treatment that is given by injection when prescribed by a specialist doctor. It is prescribed for the treatment of uncontrolled severe asthma for adults and adolescents 12 years and older. Dupixent may be prescribed by a specialist doctor for people with severe asthma who:  

  • Experience poor control of their symptoms despite correct inhaler technique and regular use of inhaled preventer treatment 
  • Experience recurrent asthma flare-ups, and   
  • Require frequent need of oral corticosteroid (OCS) treatment. 

Dupixent works to prevent the inflammation that causes asthma symptoms by blocking the pathways that lead to this inflammation. Monoclonal antibodies can only be effective if they are prescribed to treat the particular type of inflammation relevant to that individual. Dupixent works on 2 types of inflammation: ‘eosinophilic’ and ‘allergic’ inflammation.  

WHAT HAS CHANGED? 

Dupixent (dupilumab) is a new addition to the list of monoclonal antibody medicines recommended in Australian guidelines and subsidised by the PBS for use in severe uncontrolled asthma. When a specialist considers Dupixent is appropriate to treat severe asthma, they will prescribe it for injection every two weeks. Usually, injections will be given in a specialist’s rooms or severe asthma outpatient clinic, day procedure unit or day hospital. After 2-3 injections, the specialist will often arrange for the next injections to be provided by your regular GP, in a local health care facility and may also discuss how to enable you to administer the injection yourself, in your home.   

HOW WILL THIS CHANGE IMPACT ME? 

For people with asthma and their health care providers, it provides another option to be considered as medical treatment is tailored to their individual needs.  

As with everything in asthma, not every medicine and device will work for everybody. In the case of severe uncontrolled asthma, your doctor or team will thoroughly investigate your condition and the type of inflammation you have in order to recommend the precise treatment available to treat that inflammation.  

We understand that many people with asthma endure ongoing, burdensome asthma symptoms and frequent flare-ups without a plan in place to break that cycle. Asthma Australia strongly recommends that people with asthma who experience the following discuss their treatment plan with their doctor: 

  • Symptoms more than twice per week   
  • Those who have experienced a flare up in the past year 
  • Limitation to their daily lives, and 
  • Troubling side effects from their treatment. 

Most people with asthma can gain control of their symptoms and restore their quality of life however there will be some (approximately 5%) who will need specialist care including access to injectable monoclonal antibody treatment. If you’re not on specialist treatment, there might be one available for your specific condition. 

Don’t just put up with the burden that asthma is causing you. With the increasing number of specific treatments available, it is possible that you will be able to work with your doctor to reduce this burden and live the life you want. 

IN SUMMARY 

  • Dupixent (dupilumab) is a new medicine available in Australia for people with severe uncontrolled asthma, when prescribed by a specialist doctor, for people aged 12 years and over 
  • Dupixent is a monoclonal antibody medicine, which targets the pathways that lead to the inflammation which cause asthma symptoms 
  • The list of asthma medicines available for use in severe uncontrolled asthma in Australia is growing which might provide you and your treating health professional with more options to tailor your treatment to your individual needs 
  • Together you should be aiming for improved asthma control, reduced need for oral corticosteroids (OCS), and protection of your lung health. You should also not lose sight of your own personal wellbeing and lifestyle goals. 
  • Even when started on specialised monoclonal antibody treatment, it is critical that you use your preventer inhaler regularly as prescribed. Ensure you use the device correctly and you have an updated Asthma Action Plan which clearly describes your medical treatment plan, what to do if asthma worsens, and when to seek medical assistance.  
  • If symptoms are still not controlled whilst using Dupixent it is important to review your asthma urgently. 

Want to know more? For more information about Dupixent or to speak with an Asthma Educator about your asthma, call 1800 ASTHMA (1800 278 462).