Dr Dan Ouellette: New Asthma Guidelines Help to Fill a Treatment Gap

Updated asthma guidelines touch on some challenging areas in disease management and treatment, noted Dan Ouellette, MD, MS, FCCP, senior staff physician and director of the Respiratory Ward at Henry Ford Hospital and associate professor of medicine at Wayne State University School of Medicine, in an interview for this year’s CHEST Annual Meeting. Oullette is moderating “Treatment of Severe Asthma: Updates from the Guidelines,” parts 1 and 2.

Transcript

As moderator, what will “Treatment of Severe Asthma: Updates from the Guidelines,” parts 1 and 2, encompass?

Sure, there're 2 sessions that are devoted for 2 updates from the guidelines. One of them is an update of new guidelines that have been developed. The GINA [Global Initiative for Asthma] guidelines have existed for a while and implicate the treatment and management of asthma. The GINA guidelines are updated periodically. So there is a new 2020 update of the GINA guidelines, and I'm looking forward to hearing information about that update.

There also is a new guideline that has been produced by the European Respiratory Society [ERS] and the American Thoracic Society [ATS]. And this new guideline fills a gap on treatment elements, and there will be information and an update provided on that new guideline.

Finally, there'll be, in the first session, a talk about implementation of guidelines. That's always a challenge for us. It's not easy, but the work of developing a guideline only becomes important when you can take the things that you've learned and implement them into practice. And sometimes our biggest barrier is actually turning into reality those things that we know should work and getting practitioners to adopt the practices that we suggest and support in a guideline. That third talk will be about implementation, which I think will be important.

There's a second session on the guidelines also. And I think that, to me and to many advanced practitioners, may even be more interesting because what will be talked about in the second session are those elements that are implicated in the guidelines.

But these talks go beyond the guidelines to touch on areas that are interesting and different and where we're challenged. So one of those talks will be about anti-IL-5 treatments. These biologic agents are being used, and they are supported especially in the ERS/ATS guideline. But what this talk will be about is, what do you do when those agents don't work? And I think that will be really an interesting talk for us.

The other, the second talk, will be about how to manage patients with what we call non–Th2-type asthma. And this also is a challenge for us. We have developed, in the science and medical practice of patients with asthma, we've developed grouping patients into whether whether or not they have Th2-type inflammation. And many of the biologic agents that we’re beginning to use are focused or targeted for the Th2-type phenotype patient. And so this talk will be about, what do you do when the patient doesn't have that that phenotype, is not in that group? What choices do you have?

And then the third talk in that session will be, because there are several different biologic agents available, which one do you choose? And so I think that'll be a fascinating talk. Those elements are not directly addressed in our guidelines, but they obviously are very closely related. And I think we'll learn a lot from those talks.