Severe Bronchial Asthma in the era of biological treatments

Severe bronchial asthma is a chronic heterogeneous disease that requires a combination of therapies in order to be sufficiently controlled. A significant number of patients, however, do not achieve adequate control, leading to frequent exacerbations, impaired quality of life and increased health care costs. In recent years, several biological agents for severe asthma treatment have been introduced in the market or are under development. Although, biological treatment regimens for severe asthma are increasing our perspective about future asthma approach for specific asthma phenotypes and endotypes, still certain issues are raised concerning their appropriate use in line with everyday clinical practice. Pulmonary and Respiratory Medicine International Journal Submit your Article | www.ologypress.com/submit-article Ology Press Citation: Manoloudi E, Steiropoulos P. Severe Bronchial Asthma in the era of biological treatments. Pulm Resp Med Int J. (2018);1(1):6-9. 7 Anti-immunoglobulin E More than 50% of patients with poorly controlled asthma have allergic immunoglobulin E (IgE)-mediated asthma.10 IgE has a crucial upstream role in the inflammatory cascade of allergy and allergic asthma.6 Omalizumab is the only biological anti-IgE agent currently approved for humans.10 It was approved by the FDA in 2003 and by the European Union in 2005 as add-on treatment for patients aged >12 years with severe persistent allergic asthma who have serum total IgE levels 30-700 IU/mL.10 It is a recombinant DNA derived humanized IgG1 monoclonal antibody, which was originally constructed as a murine antibody selectively binding to human IgE.11 It has two main mechanisms of action: 1) it binds exclusively to circulating IgE in the blood and interstitial space and promotes its depletion and 2) it inhibits IgE binding to high-affinity (FcoRI) or low-affinity receptors (FcoRII) on basophils, mast cells and dendritic cells.10 As a result, it hinders the release of inflammatory mediators from mast cells reducing the recruitment of inflammatory cells, especially eosinophils, into the airways.11 As reported in clinical trials, omalizumab contributes to reduction in exacerbation rates, fewer emergency department visits and asthma related hospitalizations, better asthma symptom control, reduction in ICS or oral CS dose and improvement in asthma-related quality of life (QoL).6