From the Guidelines
For patients with bronchial asthma and COPD, the most recent and effective treatment options include triple therapy inhalers, such as Trelegy Ellipta and Breztri Aerosphere, which combine an inhaled corticosteroid, long-acting beta-agonist, and long-acting muscarinic antagonist in a single device, as recommended by the 2023 Canadian Thoracic Society guideline 1. These medications have been shown to improve treatment convenience, lung function, and patient-reported outcomes, while reducing exacerbation risk. For asthma, biologic therapies like dupilumab, tezepelumab, and itepekimab target specific inflammatory pathways, particularly for severe eosinophilic asthma, and are typically administered as injections every 2-4 weeks. In COPD, dual bronchodilator combinations in single inhalers, such as formoterol/glycopyrrolate and olodaterol/tiotropium, have also expanded treatment options. Patient-specific factors like disease phenotype, severity, and comorbidities should guide medication selection, as outlined in the 2017 Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease report 1. The 2015 American College of Chest Physicians and Canadian Thoracic Society guideline also highlights the importance of long-acting muscarinic antagonists and long-acting beta-agonists in reducing exacerbations and improving symptoms in COPD patients 1. Overall, the choice of medication should prioritize the patient's individual needs and disease characteristics to optimize outcomes and minimize adverse effects. Key considerations include the patient's symptom burden, risk of exacerbations, and comorbidities, as well as the potential benefits and risks of each medication, as discussed in the 2023 Canadian Thoracic Society guideline 1.
From the FDA Drug Label
STIOLTO RESPIMAT is a combination of tiotropium bromide and olodaterol indicated for long-term, once-daily maintenance treatment of patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema STIOLTO RESPIMAT is not indicated to treat asthma. The safety and effectiveness of STIOLTO RESPIMAT in asthma have not been established.
New medications for bronchial asthma and COPD:
- For COPD, there is STIOLTO RESPIMAT, a combination of tiotropium bromide and olodaterol, indicated for long-term, once-daily maintenance treatment.
- For bronchial asthma, there are no new medications mentioned in the provided drug label 2.
From the Research
New Medications for Bronchial Asthma
- Dupilumab, a monoclonal antibody directed against the IL-4 receptor subunit alpha, has been shown to be effective in treating severe refractory T2-high asthma 3.
- Biologics targeting the IL-4/IL-13 pathway, such as dupilumab, have been found to reduce asthma symptoms, decrease the frequency of exacerbations, and improve lung function in patients with severe asthma 4, 5.
- Real-world studies have demonstrated the effectiveness of dupilumab in reducing annual exacerbations and improving asthma control in patients with severe asthma 6.
Targeting IL-4 and IL-13 Pathways
- The IL-4 and IL-13 pathways play a key role in type 2 (T2) asthma, and targeting these pathways has been shown to be effective in reducing asthma exacerbations and improving lung function 5.
- Simultaneous targeting of both IL-4 and IL-13 by blocking IL-4 receptor α using dupilumab has yielded more consistent results in reducing asthma exacerbations and improving lung function, especially in patients with increased blood eosinophils 5.
Guiding Principles for Use of Newer Biologics
- A clear understanding of a patient's asthma phenotype is needed to guide therapy and optimize outcomes 7.
- Biomarkers such as eosinophils, fractional exhaled nitric oxide (FeNO), and immunoglobulin (Ig) E can be used to identify patients with T2-high inflammation and guide treatment with biologics 4, 7.