Allergist: only 10 percent patients with severe asthma treated biologically in Poland

Dr. Piotr Dąbrowiecki is an allergist from the Department of Internal Diseases, Infectious Diseases and Allergology of the Military Institute of Medicine (WIM) in Warsaw, chairman of the Polish Federation of Asthma, Allergy and COPD Patients’ Associations.

In an interview with PAP, he reminded that a patient can be considered to have severe asthma when, despite the use of high doses of asthma medications (inhaled steroids and bronchodilators), as recommended by the doctor, all the symptoms of asthma are still present, i.e. cough, wheezing, shortness of breath both during the day and at night, when the patient does not tolerate physical exercise and has exacerbations that require oral steroid medications. “If a patient has such symptoms, he has severe asthma and should go to one of the 60 severe asthma treatment clinics in Poland,” said the allergist.

“Currently, as part of the drug program in our country, therapy for these patients is financed with four excellent biological drugs,” the specialist told PAP. These are: omalizumab – for patients who have severe allergic asthma and allergy to year-round allergens; two drugs – mepolizumab and benralizumab – for patients with severe eosinophilic asthma, which is the predominant subtype of severe asthma, and dupilumab, a drug used in Th2 type asthma, i.e. one where the basis is a Th2-dependent atopic reaction.

Nevertheless, for 30 thousand patients with severe asthma in Poland, only 3,000, or 10%. receives biological treatment, emphasized Dr. Dąbrowiecki. Most patients are treated with oral steroids for a very long time, which causes many serious health complications, including osteoporosis and metabolic disorders.

According to the allergist, this problem results primarily from the lack of knowledge of primary care physicians (GPs) and some specialists. Research shows that only 25 percent family doctors read the latest standards of asthma treatment.

“In 2022, we published the first report on the treatment of severe asthma in Poland from the patients’ perspective. “The first obstacles to popularizing biological treatment of severe asthma in Poland were identified by specialists as the educational shortcomings of colleagues from primary care and older generation specialists who believe that there is no effective treatment for severe asthma, and the patient must take oral steroids,” explained Dr. Dąbrowiecki. He added that biological therapies currently available under the drug program are very effective, and new drugs from this group are being introduced, which are intended to act on the non-allergic and non-eosinophilic form of severe asthma.

“We conducted a survey among medical specialists, including those who work in severe asthma treatment centers. Doctors from the centers say that colleagues from the region do not send them patients with severe asthma, while doctors from the region estimate that the patients they send do not see specialists,” explained Dr. Dąbrowiecki.

According to him, doctors certainly have educational shortcomings, because the number of those who receive continuous education is small. “Those who are educated are sent to centers for the treatment of severe asthma, while those who do not train and do not participate in meetings of scientific societies treat severe asthma in the old way, i.e. they give oral steroids,” said the allergist.

He added that the Polish Society of Allergology is trying to educate specialists to properly treat asthma, especially severe asthma. “Asthma, if poorly treated, can develop into severe asthma. And epidemiological data show that in Poland only 20 percent patients with asthma have the disease under control,” said Dr. Dąbrowiecki.

Control of the disease means that the patient lives with it normally, takes medications, has no symptoms, does not wake up at night because of them and tolerates physical exercise.

“Such asthma control is possible both at the stage of mild asthma and moderate and severe asthma,” the specialist emphasized. He noted that in well-controlled asthma, the patient does not need to take short-acting bronchodilators (beta-2-agonists and anticholinergics) more than twice a week due to shortness of breath.

“If patients take these medications three or more times a week, and sometimes they take them every day, they do not have asthma control. They constitute 50 percent. sick. Some of them later develop severe asthma. That is why it is so important to treat mild and moderate asthma well,” the expert explained.

A survey conducted among doctors shows that 63 percent specialists know that patients abuse short-acting bronchodilators. “Despite everything, doctors tolerate this old approach to asthma therapy and do not change the patient’s treatment,” said Dr. Dąbrowiecki.

He added that the Polish Federation of Asthma, Allergy and COPD Patients’ Associations also tries to educate asthma patients during training courses intended for them. “We want to make patients aware that if they suspect they have severe asthma, they should suggest it to their doctor. There is a chance that they will then be referred to a severe asthma clinic,” the specialist explained.

In his opinion, every asthma patient should have a written asthma treatment plan from their doctor. “If we have a plan, we can implement it. In addition, the doctor should check whether the patient is using the medicines in the inhaler correctly. Research shows that half of patients using dry powder drugs from an inhaler make a critical error, and in the case of a pressurized inhaler, this percentage is approximately 75%. – explained the allergist.

He assessed that educating a patient with asthma about his disease is the basis for its proper control. “The patient should be explained what asthma is and why he should take medications, in accordance with the doctor’s recommendations,” said Dr. Dąbrowiecki.

He emphasized that patients are still afraid of inhaled steroids and that is why they discontinue them. Meanwhile, thanks to these drugs, it is possible to calm down inflammation in the bronchi and lungs of people with asthma.

“We also still have problems with quickly diagnosing asthma. The 2019 Access study shows that patients wait over 7 years for such a diagnosis, while the European average is 3.5 years. And only thanks to the diagnosis can you effectively treat asthma, create an asthma treatment plan and educate the patient,” concluded Dr. Dąbrowiecki. (PAP)

Joanna Morga

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