For the first time in half a century, scientists have hit on a new treatment for asthma attacks. Clinical trial results have shown that a drug called benralizumab is effective at treating acute attacks of both asthma and chronic obstructive pulmonary disease (COPD), and it works better than the current standard steroid treatment.
Asthma is thought to affect more than 262 million people worldwide, based on data from the 2019 Global Burden of Disease Study. Its symptoms include coughing, wheezing, and shortness of breath, which can worsen when people are exposed to certain triggers such as environmental allergens.
For COPD, it’s been tricky to pin down exactly how common it is, but it’s thought to be the third leading cause of death globally. Symptoms can be similar to those of asthma at first, but will typically get worse over time. This disease most often occurs in over-50s, and the main cause is smoking, as well as exposure to air pollution.
Sudden, acute symptom episodes of either disease can be fatal. About 50 percent of asthma attacks and 30 percent of COPD flare-ups are caused by inflammation resulting from large quantities of a type of white blood cell called eosinophils. These are called eosinophilic exacerbations, and risk causing permanent lung damage.
Despite the prevalence of these conditions, treatment for asthma has remained pretty much the same for the last 50 years. Steroid drugs like prednisolone are usually prescribed to try and control the inflammation in the lungs and reduce the chances of an attack, but they can have serious side effects and are not effective for all patients.
New options are needed – which is why the recent clinical trial of the drug benralizumab is so welcome. Led by scientists at King’s College London, the trial was conducted at hospitals in London and Oxford, UK.
The monoclonal antibody, which is given as an injection, is already in use to help manage some of the most severe asthma cases, but using it specifically to help asthma attacks was a new idea.
A cohort of 158 participants identified as being at high risk of an asthma attack or COPD flare-up were divided into three groups: the first received benralizumab injections and a placebo pill; the second received a placebo injection and the current standard prednisolone pills for five days; the third received both the new benralizumab injection and the standard steroid pills.
After 28 days, symptoms like coughing and breathlessness had significantly improved in those receiving benralizumab (with or without steroids). At 90 days, 74 percent of those only receiving the current standard treatment had needed further medical care. By contrast, those taking benralizumab needed fewer visits to the doctor or hospital and reported improved quality of life.
One of the patients who took part in the study was 77-year-old Geoffrey Pointing, who said in a statement, “Honestly, when you’re having a flare up, it’s very difficult to tell anybody how you feel – you can hardly breathe. Anything that takes that away and gives you back a normal life is what you want. But on the injections, it’s fantastic.”
“The big advance […] is the finding that targeted therapy works in asthma and COPD attacks,” said lead investigator Professor Mona Bafadhel. “Instead of giving everyone the same treatment, we found targeting the highest risk patients with very targeted treatment, with the right level of inflammation was much better than guessing what treatment they needed.”
“This could be a game-changer for people with asthma and COPD. Treatment for asthma and COPD exacerbations have not changed in 50 years despite causing 3.8 million deaths worldwide a year combined.”
The study is published in The Lancet Respiratory Medicine.
