Growing up in the ’60s and ’70s, we all knew kids and adults who were held back by their asthma. They sat out gym classes and sporting events, missed school or work over and over again, were up in the wee hours of the night fighting to breath, or seemed to make their own chest noises all the time. They got nicknames like Wheezy.
Jump ahead now to 2020. Although we still continue with our traditional allergy avoidance and immunotherapy programs, inhaled corticosteroid inhalers, and long and short acting airway muscle relaxing agents to treat asthma, we now have entered what is being called “The Biologic Era” of asthma treatments.
Biologic treatments are not the traditional chemical drugs we have been using for decades. Rather, biologics are antibodies similar to those we use to recognize and fight off germs. When designing biologics for asthma patients, scientists replace the recognition portion with a component that targets “problem signals” from our immune system. One family of signals or targets, known as interleukin proteins, come from T cells and tell other cells what to do. The allergy antibody IgE is another target. When the particular biologic is given, it circulates through the patient until it finds its target, and then binds to that target. The result is to change the way our body works, decreasing parts of the allergy or immune reaction that causes us to have the asthma.
All these therapy choices can be overwhelming. We now want to personalize each asthmatic’s program with the goal of “control,” meaning hopefully, no asthma. It all starts with talking to your doctor to establish an understanding of your history followed by a physical examination. You and your doctor might then decide on several options including, allergy testing, blood counts, IgE levels, nitric oxide breath measurement, x-rays, CT scans, and pulmonary function tests as indicated to determine what type of asthma you have. Armed with the knowledge obtained, your allergy doctor can prescribe the best combination of treatments to achieve control.
And as an added benefit of control, we can hopefully eliminate the use of that old nickname, Wheezy.
Mark E. Bubak, MD practicing in Sioux Falls, South Dakota is a contributing Prairie Doc® columnist. He is certified by the American Board of Allergy and Immunology to care for adults and children with asthma and allergies. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook.