In this MD Newsline exclusive interview with allergist and immunologist Dr. Sakina Bajowala, we discuss treatment strategies for patients with severe asthma. We also discuss what it would mean to optimize asthma clinical trials for communities of color.
What is your treatment strategy for patients with severe asthma?
Dr. Sakina Bajowala:
“For all patients with asthma, my focus is four-fold: reducing airway inflammation, improving lung function, controlling day-to-day symptoms, and reducing the frequency of exacerbations.
This strategy entails identifying allergic and irritant triggers for airway hyperactivity, implementing environmental control measures to reduce exposure to these triggers, desensitizing patients to environmental allergens when appropriate, using anti-inflammatory medications such as inhaled corticosteroids and short-acting and long-acting bronchodilator medications appropriately, employing lifestyle modifications, such as stress reduction, smoking cessation, exercise, diet, and sleep, and if necessary, considering the use of biologic medication.
In those patients who may not be responding to therapy, it’s important to also consider alternative diagnoses such as alpha-1 antitrypsin deficiency, COPD, or occupational lung disease. Throughout the treatment course, regular monitoring of the patient is essential.
It’s quite common for individuals to stop their daily controller medications once they start to feel a little better. So we really need to keep on top of our patients about maintaining long-term control because stopping those medications can often result in rebound exacerbations. And so, it’s really important not to let these patients fall off our radar.”
How can we optimize asthma clinical trials for communities of color?
Dr. Sakina Bajowala:
“Though we aren’t quite there yet, I am really looking forward to a future where we can gather enough data from studies that are adequately powered to analyze both the safety and efficacy of different asthma interventions in communities of color specifically. And those data will hopefully allow us to personalize and optimize our treatment strategies based on a variety of demographic, genetic, and environmental factors.
For the time being, we are working as we go along. We don’t have that level of specificity and personalization available to us just yet, but I think it’s coming.”
Responses have been condensed and lightly edited.