Severe asthma is a complex condition that impacts between 150,000 and 250,000 Canadians, according to Vanessa Foran, president and chief executive officer of Asthma Canada, during a webinar hosted last month by Benefits Canada and supported by AstraZeneca.
It’s an acute condition where people have difficulty achieving control of their disease despite proper use of standard asthma treatments, she said, noting severe asthma patients are more than twice as likely to be hospitalized. Indeed, a recent survey of Asthma Canada members found 89 per cent of patients said their main goal was to avoid visiting the emergency department or be admitted to hospital.
“Activities that other Canadians take for granted are the dream for people with severe asthma. They are praying that they don’t land in the emergency department.”
Severe asthma limits physical activity and leads to decreased productivity at work, she added. According to the survey, nearly 75 per cent of patients with severe asthma reported it affected the quality or performance of their work and 18 per cent missed work due to their daily symptoms.
In addition, 46 per cent of severe asthma patients said experiencing an asthma attack led them to fear for their life. Patients often suffer from anxiety and depression, with 66 per cent feeling hopeless and 70 per cent feeling stigmatized. Many patients said their colleagues and co-workers were unsupportive, which could lead them to keep their diagnosis a secret, said Foran.
Severe asthma can also impact a patient’s family, with 80 per cent reporting they or a family member had trouble sleeping due to their or a loved one’s asthma symptoms. As well, the proper diagnosis of severe asthma can take years, she said, noting patients reported spending up to seven years experimenting with different treatments before finding the right one.
Primary care physicians may not understand the complexity of severe asthma, which is why a referral to a specialist is often necessary. Specialists’ treatment objectives are to help patients control their severe asthma to prevent decline in lung function, said Anne Ellis, clinician scientist at Kingston General Health Research Institute and a professor in Queen’s University’s department of medicine, also speaking during the webinar.
While oral corticosteroids are an important part of the severe asthma management toolkit, Foran noted the side-effects can have a huge impact on quality of life. Short-term side-effects include fluid retention, weight gain and potentially extreme mood swings, while long-term side-effects include diabetes, osteoporosis, glaucoma, anxiety, cardiovascular disease and impaired immunity.
As a result, said Ellis, it’s important to minimize exposure to steroids as much as possible. “People still die of asthma every year in Canada, which is something that should be completely preventable when we have so many safe and effective therapies for this condition. We have lots of treatment options for asthma and some patients will need just one and some will need to progress to more advanced treatments.”
Biologic options for the treatment of severe asthma can be very beneficial, she said, adding that, for the right patient, they can be steroid sparing, reduce exacerbations and hospitalizations, while also improving lung function, symptoms and quality of life.
Asthma is a complex and heterogeneous disease involving different parts of the immune system, said Ellis. “Biologics are designed to work very specifically, so phenotyping asthma — or trying to figure out what type of asthma a patient has — is critical to [the] proper selection of the most effective biologic for that patient.”
Despite recent advances, there are still unmet patient needs, she said, noting some patients have no obvious driver for their asthma and about 50 per cent of patients on a biologic therapy will continue to experience at least one exacerbation per year. “Ultimately, biologics are needed only for a small portion of asthmatic patients, but for those who do need them, they are life-changing.”
Once a patient is diagnosed and the appropriate treatment is prescribed, financial challenges often create barriers to better health outcomes, said Foran, recommending that plan sponsors ensure their benefits plan provides access to a variety of asthma medications, so individuals can get the treatment they need. She also suggested plan sponsors recognize the personal, social and financial burden of employees with severe asthma and provide accommodations when requested, in addition to promoting an understanding of asthma in the workplace to fight associated stigma.
Ellis closed by sharing a case study from her practice — a 34-year-old female with asthma who was on long-term disability. Over the years, the patient had numerous visits to the emergency department and hospitalizations and suffered from several comorbidities. She was taking multiple medications and had become steroid-dependent, which was accompanied by many of the known consequences, such as osteoporosis and cataracts.
After Ellis started the patient on a biologic therapy, she was able to come off steroids, hadn’t been to the emergency department or admitted to hospital and was able to return to work full time. She noted this was just one of the many successes stories of those who benefitted from biologic treatment.