Asthma Biologics

Rapid Uptake Products (RUP) 

The Accelerated Access Collaborative (AAC) is the umbrella organisation for UK health innovation. It supports the NHS to quickly adopt proven and cost-effective innovations, and to ensure patients get access to the best new treatments and technologies. It does this through the Rapid Uptake Products (RUP) programme.  This programme delivers bespoke support initiatives to increase system wide uptake and spread. 

Asthma

Asthma is a long-term condition that affects your airways – the tubes that carry air in and out of your lungs. It usually causes symptoms such as coughing, wheezing and breathlessness. If someone with asthma comes into contact with an asthma trigger, it can make symptoms worse and even bring on an asthma attack.  

Asthma accounts for 2-3% of primary care consultations. It impacts on everyday life such as education and work, leads to 60,000 hospital admissions and 200,000 bed days per year in the UK. Asthma attacks kill three people in the UK each day and every 10 seconds someone has a potentially life-threatening asthma attack. However, many of these severe attacks and deaths could be avoided by taking simple measures to improve care. The key challenges for the health system with regards to asthma are early diagnosis, correct treatment and good education to enable self-management.

Severe asthma

Severe asthma is a type of asthma that cannot be controlled with regular asthma treatments, such as inhaled steroids and long-term bronchodilators, despite good adherence to treatment and optimised inhaler technique.  More than 100,000 people in the UK may have severe asthma, which, if uncontrolled, puts them at risk of poorer health outcomes and often severely impacting their quality of life. 

About biological therapies

Biological, or biologic, therapies are a type of medicine called monoclonal antibodies, and work in a different way to other asthma treatments.  They may be offered to people with severe asthma, and can improve symptoms and reduce asthma attacks by helping to stop the body processes that cause lung inflammation.

NICE has published several evidence-based recommendations around the use of biological treatments as an option for treating severe asthma in patients who meet certain criteria: 

·       Omalizumab is for people with severe allergic asthma. It targets immunoglobulinE (IgE), a chemical found in the bloodstream.  IgE is produced in response to environmental allergens such as house dust mites, pollen and moulds, which can act as triggers for allergic asthma symptoms.

NICE have published technology appraisal guidance for three different therapies used in the treatment of severe eosinophilic asthma:

·       Benralizumab targets and depletes the immune cells (eosinophils) in the body which cause severe asthma, and can reduce the inflammation that leads to asthma symptoms and asthma attacks.

·       Mepolizumab is another biological treatment for severe eosinophilic asthma which work by reducing the number and activity of eosinophils in the blood

·       Reslizumab similarly inhibits interleukin‑5 to reduce eosinophils and lower inflammation during an allergic reaction

These treatments can only be prescribed from Specialist Asthma Centres, following a confirmed diagnosis of severe asthma and discussion at a multidisciplinary team meeting. 

Examples of transformation projects

Local projects

Developing the role of the Biologics Pathway Co-ordinator

University Hospital Southampton NHS Foundation Trust hopes to improve asthma care within their expanding service by developing the role of a dedicated Patient Co-ordinator within their asthma biologics pathway.  As well as reducing duplication and delay, this role hopes to free up members of the clinical team so that more time can be dedicated to their clinical commitments.

Community-based specialist respiratory nurses for patient identification

NHS Dorset CCG plans to use their regional data service (Dorset Insights and Intelligence Service) to identify patients potentially suffering from severe asthma at a PCN level.  Community-based specialist respiratory nurses will then be able to review identified patients, prior to considering referral to secondary care for further diagnosis and, where appropriate, treatment with asthma biologics.

Resources

Asthma Biologics Toolkit- this includes a number of resources for clinicians including guidance, webinars, podcasts and the newly launched patient information leaflets in a variety of languages

Advice and support for the public can be found at:

NHS UK  https://www.nhs.uk/conditions/asthma/

Asthma UK https://www.asthma.org.uk/ 0300 222 5800

Allergy UK https://www.allergyuk.org/ 0132 261 9898

Action Against Allergy https://actionagainstallergy.org/ 0208 892 2711

British Lung Foundation https://www.blf.org.uk/ 0300 003 0555

Wessex AHSN is not responsible for the quality or accuracy of any information or advice provided by these organisations.

REFERENCES:

1. Price D et al, NPJ Prim Care Respir Med 2014; 12(24): 14009

2. Fernandes AG et al, J Bras Pneumol 2014; 40(4): 364-372

3. Pieter-Paul W et al, J Allergy Clin Immunol 2015; 135(4): 896-902