Because new biologic treatments for asthma can be expensive and cause side effects, we need to come up with a protocol that lists specific factors, such as how well patients follow their treatment plan, so that only the patients who will benefit from biologic treatment are given it. Along with many other things, this has been one of the RASP-UK consortium's goals for the past 3 years. At the recent RASP-UK Annual Consortium Meeting, people heard about the published results of a part of the project that looked at what happens when people with severe asthma don't follow their treatment plans [1]. Poor adherence is common in difficult-to-control asthma, making the identification of patients with difficult-to-control asthma who respond to inhaled corticosteroids from refractory asthma clinically challenging.

Suppressing fractional exhaled nitric oxide (FeNO) with directly watched corticosteroid therapy over 7 days has been suggested as a way to find patients who aren't following their corticosteroid treatment. Using remote monitoring technologies, the RASP team looked into whether FeNO suppression testing could be done and how useful it would be in regular clinical care in its UK severe asthma centres.

To provide FeNO suppression testing, web-based recording and built-in remote tracking technology have been created. As part of our ongoing research, we looked at the clinical worth of testing and how well it could show how steroid drugs work and provide clinical benefit.

The study successfully showed that monitoring FeNO suppression from afar is a good way to find people with difficult-to-control asthma who aren't taking their inhaled corticosteroids as prescribed. This includes a large group of patients who are likely to benefit greatly from better inhaled asthma therapy.

The findings have already received an enthusiastic reception in the literature [2]. A recent review praises the progress made in creating a useful, standardised method for checking adherence and inflammation control that can tell the difference between patients who need a biologic medication and those whose symptoms aren't getting better because they aren't following standard inhaled therapy. It's clear that RASP-UK is a well-run and successful consortium that will soon be delivering exciting and clinically useful results.

References

1. Heaney LG, Busby J, Bradding P, et al. Remotely Monitored Therapy and Nitric Oxide Suppression Identifies Non-Adherence in Severe Asthma. American Journal of Respiratory and Critical Care Medicine [online ahead of print] 19 Oct 2018; www.atsjournals.org/doi/abs/10.1164/rccm.201806-1182oc
2. Bender B. Sorting out nonadherence and airway inflammation in treatment escalation for severe asthma. AJRCCM Articles in Press. Published on 13-December-2018 as 10.1164/rccm.201811-2144ED