Three new drugs are revolutionising the lives of Britons with a devastating form of asthma. Unlike other medicines, which merely address the symptoms, these get to the very heart of the condition – with remarkable results.
The latest breakthrough came last week when NHS chiefs gave the green light to benralizumab, also known by the brand name Fasenra, a monthly jab that helps sufferers who have exhausted all other treatment options, and are regularly hospital-bound due to breathing problems.
The drug joins mepolizumab, or Nucala, and reslizumab, also called Cinqaero, which were approved two years ago to treat eosinophilic asthma, a severe form of the disease.
Rachel McCarthy, a 43-year-old company director, has gone from being barely able to walk up the stairs to climbing mountains since being prescribed mepolizumab
The benefits can be dramatic. Rachel McCarthy, a 43-year-old company director, has gone from being barely able to walk up the stairs to climbing mountains since being prescribed mepolizumab.
She says: ‘Within three months I noticed a dramatic improvement and in June last year I climbed Ben Nevis, something that had been beyond my wildest dreams.
‘To stand on the top as an asthmatic and breathe the most wonderful air into my lungs was the most beautiful thing in the world.’
Experts are increasingly aware that asthma isn’t just one disease but a collection of conditions that need to be treated differently.
Eosinophilic asthma can’t be controlled with normal inhalers, even at high doses. As a result, the 100,000 Britons with the condition are often prescribed powerful steroid pills which risk side effects from diabetes and weight gain to mood swings and osteoporosis. However, many still end up in hospital with life-threatening attacks.
Eosinophilic asthma, which normally develops in adulthood, is triggered by inflammation-causing white blood cells called eosinophils gathering in the airways.
The three new drugs are man-made antibodies designed to block IL-5, an immune system chemical that attracts eosinophils to the airways and helps them thrive. In trials, the drugs halved the number of attacks patients suffered and significantly improved quality of life.
They are prescribed by specialist centres and given as jabs or infusions every four to eight weeks in hospital. If they work, patients can cut back on their oral steroids. However, they still have to take their inhalers. Side effects include tiredness, headaches, fatigue and back pain, and increased susceptibility to infections.
Mepolizumab, reslizumab and benralizumab belong to a class of drugs known as biologics, and they work in slight different ways.
Rachael McCarthy from Lincoln, whose severe asthma is now under control due to a new drug she is taking
Researchers are trying to work out how to ensure a patient gets the one that is best for them. They are also trying to create versions that can be given at home rather than in hospital.
Dr Samantha Walker, an asthma and allergy expert and director of research at charity Asthma UK, said that while biologics are not a cure and do not work for everyone, in some people the effects are life-changing.
‘I’ve known people with severe asthma to give up work or retire ten years early,’ she says.
‘People get slower and slower because they don’t want to not be able to breathe.’
Dr Walker added: ‘For those who respond to biologics, they really are game-changing.’
Rachel’s asthma was so severe that she stopped socialising, gave up playing sport and could barely get up the stairs. She says: ‘I had my first asthma attack at 22, and since then my asthma took over my life. By my 30s I was being admitted to hospital on a monthly basis with severe attacks.
‘I was put on high-strength steroids, and although they helped me to breathe, they made me put on a lot of weight and left me very depressed. My husband Rick knows only too well that at times I felt like I couldn’t go on.’
Since starting monthly injections of mepolizumab in October 2017, she has stopped taking steroids, gone back to the gym, dropped two dress sizes – and climbed Britain’s highest mountain.
The dramatic improvement in her health also means that a long-held dream to have a family has become a possibility. ‘It’s hard to take in how this new drug has given me my life back after so many years of literally wanting my life to be over,’ says Rachel, from Lincoln.
Meindert Boysen, head of technology evaluation at the NHS drugs watchdog, the National Institute for Health and Care Excellence (NICE), says: ‘People with severe eosinophilic asthma that is inadequately controlled often have severely impaired quality of life – it can hold them back from doing many basic daily tasks, lead to psychological problems including anxiety and depression and leave them in constant fear of a potentially lethal asthma attack
‘By keeping their asthma better under control, biological treatments have transformed the lives of these sufferers.’
- Asthma UK funds research into the development of ground-breaking asthma treatments. To donate, visit asthma.org.uk/donate.
Ever wonder why…
People say you shouldn’t read on the toilet?
It may be the only place you get any peace – but reading while on the loo is potentially bad for us. Physiotherapist Sammy Margo (sammymargo physiotherapy.com) explains: ‘Like any muscle, the pelvic floor, which holds the pelvic organs in place, needs to be used correctly. Anything that puts pressure on it – including adopting a ‘voiding’ position for longer than needed – will cause weakening. Focus on going to the toilet – not reading – and don’t spend more than ten minutes having a bowel movement.’