Asthma is a condition that causes symptoms of shortness of breath due to sudden narrowing of the opening of the airways. Other asthma symptoms include wheezing, chest tightness and coughing. An estimated 39.5 million people in the U.S. suffer with asthma (10.5 million are children). Asthma** can be controlled by taking medications and** avoiding triggers.
The airway narrowing in asthma happens in two forms:
Spasm of the muscles that surround the airways, with the treatment including traditional medications and bronchodilators to relax the muscles responsible for the spasm. Albuterol (Pro-air, Ventolyn), Salmeterol (Serevent), and Formoterol (Symbicort) are all bronchodilators.
A more persistent form that causes thickening of the inner layer of the airways. This process is identified as airway inflammation. The treatment for this form aims at reducing inflammation and re-optimizing opening of the airways. The drugs used in this case are classified as anti-inflammatory agents. Choices are limited and come from a class of drugs called corticosteroids. Beclemethasone (QVar), Fluticasone (flovent) and Bedesonide (Pulmicort) are all inhaled corticosteroids. These drugs in tablet (oral) form have many unwanted side effects, so the inhaler versions are used as the first line treatment.
Unlike bronchodilators which have recently seen a surge in new options, there have been no innovations in the category of anti-inflammatory agents. A new pill may be a game-changer in the treatment of asthma.
Fevipiprand ( QAW039) is undergoing clinical trials and has been shown to reduce the severity of the asthma obstruction. It’s currently in late stage clinical trials. This drug is unique, because unlike inhaled steroids which are used as first line treatment in patients with mild to moderate disease, Fevipiprant has been studied and tested in patients with severe asthma. There is also clear clinical data with objective measures of its effects from the clinical trials.
Researchers at University of Leicester involved in the current study are calling this drug, “the first new asthma pill for nearly 20 years that has the power to reduce severity of the disease.” Fevipiprant comes in a pill form so that it assures the complete absorption of the medication. Individuals sometimes do not use inhalers properly, which can result in missing some of the medication being inhaled.
This study assessed airway inflammation by measuring cells in the sputum called eosinophils. Eosinophils are subtypes of white blood cells that are involved in allergic reactions. The presence of eosinophils in sputum is characteristic of asthma and is used as a measure of airway inflammation.
This new medication reduced the eosinophil count significantly when compared to another group taking a placebo. The results were also validated by using CT scans and breathing tests to see the impact of the drug. Improvement was significant across all measures.
Fevipiprant is being touted as a game changer. It’s important to understand the danger of leaving airway inflammation untreated, even when there are no symptoms. Untreated airway inflammation can result in permanent changes in the airways, with permanent narrowing and irreversible asthma. This process is called airway remodeling. It is with this in mind that more objective measures were designed to define and identify airway inflammation.
Fevipiprant improved lung function and also had a safe profile. Improvements were noted across all testing: breathing tests, airway wall sampling and CT scans of the chest. The drug shows promise in helping to stop preventable asthma attacks, improving day-to-day quality of life, and reducing hospital admissions associated with asthma.
The new drug and research funded by Novartis Pharmaceuticals is the product of a partnership between the National institute for Health Research (NIHR) in the U.S. and the European Union Airway Disease Predicting Outcomes through Patient Specific Computational Modeling. AirPROM is a five-year project which aimed to produce computer and physical models of the whole human airway system for people with asthma and COPD. Results of the study were published in The Lancet Respiratory Medicine journal.
Because of what we’ve learned from this specialized model, treatment can be individualized and measures used to assess improvement in this complicated disease. Thanks to the information provided by AirPROM, it is likely that other new drugs will be developed for the treatment of asthma.
Eli Hendel, M.D. is a board-certified Internist and pulmonary specialist with board certification in Sleep Medicine. He is an Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, Qualified Medical Examiner for the State of California Department of Industrial Relations, and Director of Intensive Care Services at Glendale Memorial Hospital. His areas of expertise in private practice include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases.