Nov. 12, 2023
Can asthma go into remission? The success of biologic medications has led many allergists and pulmonologists to consider it a possibility. Asthma remission was among the key issues discussed at the 9th annual USAsthma Summit, held on Nov. 10, 2023 in Anaheim, California.
Biologics have proven to be a game-changing treatment for many people with moderate to severe asthma. Six different biologics are available on the market.
“We are actually finding people under well-enough control that we can now define clinical remission,” says Kathleen May, MD, ACAAI President. “I don’t think we’ve ever been to a point where we could even begin to make a definition for clinical remission. So this is exciting.
“But this is just a starting point. The idea for this definition is more for research, to follow these patients along. It is not clinically applicable yet. But we will be looking at this over time and refining it to determine how we can define remission.”
Dr. May went into more detail about the potential for asthma remission during a presentation at the USAsthma Summit. Check out more of her presentation below.
The USAsthma Summit is hosted by Allergy & Asthma Network each year. It is timed to coincide with the ACAAI Annual Scientific Meeting. More than 60 people attended the Summit in person and another 350+ joined our interactive livestream.
The USAsthma Summit provides an up-to-date look at the state of asthma care in the United States. Each year, the Summit brings together…
- asthma coalitions
- state asthma programs
- doctors
- school nurses
- community health workers
- asthma patients and their caregivers
- patient advocates
- key stakeholders in asthma care
During the Summit, presenters advanced Guidelines-based asthma care. They also discussed best practices and lessons learned from U.S. asthma programs. Patients and caregivers were also in attendance. They shared their stories of living with asthma.
“In the last 30 years, there has been so much innovation and science for people who are living with asthma,” says Lynda Mitchell, CEO of Allergy & Asthma Network. “There are new options and treatments that didn’t exist 30 years ago – like biologics, which are miracle drugs for many people with severe asthma. We have better guidelines for asthma management and education opportunities so people who care for those with asthma can instruct them on how to live and manage their asthma day to day.
“Asthma control is still a struggle for many, though. So we’re hoping to share some interesting ways to learn more about asthma control and how you can share that with your patients.”
Giving a Voice to Asthma Disparities through Education and Awareness, Nancy Joseph, DO, USAsthma Summit Moderator, Board-certified in Pediatrics, Allergy and Immunology, Medical Advisor for Allergy & Asthma Network
8:40 mark in video
The emergence of new asthma medications has led to remarkable progress in asthma care – but this progress is not reaching everyone. Dr. Joseph addressed ongoing asthma disparities in the United States – particularly those affecting the African American, Hispanic/Latino and Native American communitie. She also cited the need for greater health equity.
African Americans are…
- 30% more likely to have asthma
- 3 times more likely to have an emergency department visit due to asthma
- 3 times more likely to die due to asthma
In addition, African American children are 7 times more likely to die from asthma than their non-Hispanic white counterparts.
Social determinants of health – nonmedical factors that influence health outcomes – “affect every aspect of society,” Dr. Joseph says.
What can be done to advance health equity? Dr. Joseph cites raising awareness of the impact of asthma and allergic diseases on under-resourced communities. Patient advocacy for legislation and policies that support positive health outcomes and improve access to affordable and effective care is also essential for health equity.
Allergy & Asthma Network’s Trusted Messengers program is an initiative designed to promote equity in healthcare. It is built on a belief in community-led solutions and involves partnerships with local churches, community groups, health centers and doctors. The program is designed to help people get the knowledge and care they need – from trusted, credible sources – to adopt healthy behaviors and make informed decisions about their health.
Current State of Asthma in the United States, Kathleen May, MD, President, American College of Allergy, Asthma & Immunology
27:32 mark in video
In September 2023, ACAAI, the American Academy of Allergy, Asthma & Immunology (AAAAI) and the American Thoracic Society co-published a consensus statement on clinical remission of asthma.
During Dr. May’s presentation at the USAsthma Summit, she further explained what allergists and pulmonologists could look for when evaluating asthma remission. The following would have to be met over a 12-month period by a patient undergoing biologic therapy:
- No asthma attacks requiring a physician visit, emergency care, hospitalization, and/or oral corticosteroid use.
- No missed work or school days due to asthma.
- Stable and optimized pulmonary function, with a minimum of two measurements during the year.
Other criteria would involve how often patients use certain therapies and results of asthma assessment questionnaires and/or tools.
The consensus statement on clinical remission of asthma does not create any change in how doctors currently treat patients, Dr. May emphasizes. It allows allergists and pulmonologists to gather more data, which will go toward developing guidance on asthma remission.
The Impact of Social Media in Patient Care Decisions, David Stukus, MD, Professor of Clinical Pediatrics, Division on Allergy and Immunology, The Ohio State University College of Medicine
1:10:48 mark in video
Dr. Stukus examined the healthcare media landscape, which now includes content generated by artificial intelligence, or AI. He showed how opportunists are using social media to promote asthma cures, when no cure exists. And he provided some solutions to help healthcare professionals, patient advocacy groups and patients can get past misinformation:
- Engage with patients and the public, even on social media. “Become an asthma myth-buster,” Dr. Stukus says.
- Use technology and media platforms to share evidence-based information.
- Partner with community groups and local organizations.
Dr. Stukus capped off his presentation by sharing a quote that was generated by AI: “It’s essential for both patients and healthcare professionals to approach social media with critical thinking and verify information from reliable sources. While social media can offer valuable support and information, medical decisions should ultimately be based on evidence-based practices and advice from qualified healthcare providers.”
California Breathing and the Asthma Management Academy (AsMA) Model, Natalie Sacramento, MPH, California Department of Public Health.
2:09:40 mark in video
Natalie Sacramento provided insight into asthma in California, site of the USAsthma Summit. Approximately 5.7 million people – about 1 in 7 – live with asthma in California.
African American and Native American Californians are more likely to have severe asthma and die from asthma. Hispanic/Latino Californians are less likely to have asthma than white Californians, but more likely to have severe asthma.
Sacramento discussed the state’s AsMA program, which trains community health workers to:
- Provide evidence-based asthma self-management education, including proper technique and use of inhalers.
- Conduct an in-home asthma trigger assessment.
Among people with poorly controlled asthma who took part in asthma education with community health workers:
- 83% had reduced emergency department visits and hospitalizations;
- 70% had fewer missed school or work days;
- 70% had improved asthma control.
Asthma Medications and Management: Empowering Patients to Learn Their Options, Corinne Young, MSN, FNP-C, FCCP, President of the Association of Pulmonary Advanced Practice Providers (APAPP); De De Gardner, DrPH, RRT, RRT-NPS, FAARC, FCCP, Chief Research Officer, Allergy & Asthma Network
2:50:55 mark in video
Corrine Young provided a closer look at available asthma combination treatments, including Single Maintenance and Reliever Therapy (SMART).
SMART is a combination of an inhaled corticosteroid (budesonide) and long-acting beta-agonist (formoterol, an anti-inflammatory) using a single inhaler. It is for daily maintenance therapy and the relief of symptoms as needed. SMART allows moderate to severe asthma patients to get daily medicine to keep their airways open. If they experience symptoms, the anti-inflammatories help reduce airway inflammation.
A new budesonide and albuterol combination is also available. It’s a quick-relief and prevention medication for people 18 years or older with moderate to severe asthma. Research shows that combining these two medications reduces inflammation and helps stop the progression of an asthma attack.
Allergy & Asthma Network’s De De Gardner presented research on the perception and use of oral corticosteroids for asthma. (Note: slides are not available for this presentation.)
Many parents of children with asthma perceive oral corticosteroids as safe and they anticipate using them for asthma attacks. They were aware of the short-term side effects (weight gain, insomnia, mood changes), but not as familiar with long-term side effects (eye problems, diabetes onset, thinning bones and increased risk of infections).
Parents recognize that biologics can decrease the frequency of asthma symptoms and reduce the need for oral corticosteroids. But the average out-of-pocket costs for biologics are $1,292.
The Story of Tony, Laonis Quinn, RN, MSN, AE-C. Founder, The Breathe Anthony J. Chapman Asthma Foundation.
4:31:40 mark in video
Laonis Quinn of Detroit shared the store of her son Anthony J. Chapman, who passed away after a severe asthma attack in 2007.
Anthony’s asthma was mostly under control until his pulmonologist could no longer accept his health insurance provider. He had to turn to clinics that provided substandard care. His asthma flares worsened, leading to many emergency department visits.
A year later, Anthony passed away at the age of 23. “I still remember my scream, I still remember that moment – I’ll always remember it. My life has been changed since that unthinkable day,” Laonis says.
Two years after Anthony’s death, the Affordable Care Act was signed into law. If passed sooner, the measure would have allowed Anthony to stay on Laonis’s health insurance through age 26. He would have been able to maintain his quality care.
Laonis founded the Breathe Anthony J. Chapman Foundation to share Anthony’s story and raise awareness of the severity of asthma. She serves on the Board of Directors at Allergy & Asthma Network.
Barriers to Medication Adherence in Asthma: The Importance of Culture and Context, Elizabeth McQuaid, PhD, Vice Chair of Academic Affairs and Director of Child Psychology at Rhode Island Hospital/Hasbro Children’s Hospital; Director of the Division of Clinical Psychology, Vice Chair of the Department of Psychiatry and Human Behavior at Brown University.
4:50:35 mark in video
Elizabeth McQuaid presented research on how health disparities and other barriers can affect medication use. “Consistent medication use is necessary to control asthma, but most people don’t take medication daily,” she says.
Why? Medication beliefs and use differ by race and ethnicity. Cultural beliefs, some of which have historical roots in mistreatment, can affect medication use. Provider bias can impact care. Research shows African American and Hispanic/Latino patients are less often referred to asthma specialists compared to whites.
Other cultural factors that impact adherence include age-based developmental transitions. For example, adolescents with asthma entering high school may be less inclined to follow their treatment play. In addition, some patients may turn to herbal remedies when they cannot access medicine, or in conjunction with medicine.
Healthcare professionals can address medication barriers with open communication during office visits. Studies show digital devices, such as text messaging and mobile apps, can help motivate people to “take medication as directed,” McQuaid said.
Indoor Air Quality: A Social Determinant of Health, Sheila Brown, Project Analyst, U.S. Environmental Protection Agency (EPA); Anne Kelsey Lamb, MPH, Director, Regional Asthma Management & Prevention (RAMP), A Project of the Public Health Institute
5:32:22 mark in video
Sheila Brown and Anne Kelsey Lamb discussed how in-home and virtual environmental assessments and remediation can help people living with asthma.
They introduced a new term – indoor environmental determinants of health, or IEDOH – to help identify indoor air factors that are fixable. These factors include household air pollution, the presence of pests, mold and moisture, chemicals and irritants.
“We hope this terminology will help drive progress and action,” Brown said. “It brings into focus the critical role of indoor air quality in asthma care.”
The RAMP program uses the proven intervention of asthma home visits and expands them to more under-resourced communities. This can help reduce asthma disparities. The program includes home trigger assessments, remediation supplies and services if needed, and comprehensive asthma education.
Download the Sheila Brown presentation
Download the Anne Kelsey Lamb presentation
GINA 2023 Updates and the Future of Asthma Care, Angela Hogan, MD; Children Hospital of the King’s Daughters.
6:33:27 mark in video
The Global Initiative for Asthma (GINA) updates its guidelines for asthma management every year. Dr. Hogan spotlighted some of the key changes in this year’s GINA guidance.
- The inhaled corticosteroid and formoterol combination inhaler is preferred for stepping up or stepping down asthma treatment. Studies show it is effective and safe, and it involves just one inhaler device. “This can help avoid confusion,” Dr. Hogan says.
- The FDA-approved budesonide-albuterol combination is the first inhaled corticosteroid and short-acting beta-agonist on the market. It’s prescribed for as-needed treatment and prevention of asthma symptoms in adults. It also involves just one device. The MANDALA study showed the budesonide-albuterol combo prevented asthma attacks better than albuterol alone.
- Biologic therapy for asthma should only be prescribed when asthma is severe and other treatment options have been considered. “GINA is saying we should not escalate to biologics until it’s proven the patient has severe asthma,” Dr. Hogan says.
- Doctors can consider a short course of an inhaled corticosteroid for children 5 years of age and under who are wheezing regularly as a result of a viral illness.
- Patients should have two asthma inhalers, if possible. Keep one at home and one in a backpack or bag that you carry with you away from home.
- As SMART becomes more commonly used in asthma treatment, doctors and patients should consider developing a SMART Asthma Action Plan.
EPA Award Winner: The Wisconsin Asthma Program. How Collaboration, Data, Equity Goals (And Perseverance) Improve Asthma Outcomes in Wisconsin, Erika Kluetmeier, Environmental Health Communications Strategist, Wisconsin Department of Health Services
7:23:15 mark in video
Each year, EPA awards the National Environmental Leadership Award in Asthma Management. The 2023 winner is the Wisconsin Department of Health Services’ Asthma Program.
The Wisconsin Department of Health Services’ Asthma Program successfully delivers high quality asthma care statewide by building strong community ties, integrating healthcare services, and tailoring environmental interventions. Serving nearly 6 million state residents, the program activities focus on disproportionately affected populations including children, people with low income, and racial and ethnic minorities.
The Wisconsin Asthma Program involves strong partnerships with community organizations and innovative projects, including the Asthma-Safe Homes Program. The program builds upon a pilot asthma home-visiting program, the result of a collaboration with Medicaid to provide sustainable asthma funding.
We are incredibly grateful to ACAAI for their support and the meeting space for the USAsthma Summit. We are also incredibly grateful to our corporate partners who’s sponsorship of USAsthma funded the program as well as the scholarships offered to 50 in-person attendees.
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