Kelly Colas, DO, PhDa; Kavita Vyas, MDb,c; Dipa K. Sheth, MDa,c,d Correspondence: Kelly Colas (kcolas@uw.edu)
aDepartment of Allergy and Immunology, University of Washington, Seattle bDepartment of Pulmonary and Critical Care, Washington DC Veterans Affairs Medical Center cGeorge Washington University, Washington, DC dUniformed Services University of the Health Sciences, Bethesda, Maryland
Author disclosures
The authors report no actual or potential conflicts of interest or outside sources of funding with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
Ethics and consent
The intention of this project was to examine the implementation of a program for the improvement of patient care. As this project is qualitative improvement, it did not qualify for institutional review board approval.
There was a notable clinical improvement in these patients. Before starting a biologic agent, all the patients in this study were prescribed steroids at least once a year for an asthma exacerbation, with a mean of 4.2 steroid tapers per year.
After starting a biologic, only 3 of 15 patients required steroids for an exacerbation, with an average of 0.6 steroid tapers per year (Figure 2). Additionally, there was notable improvement observed in patients’ FEV1, with a mean of 10% after the initiation of a biologic (Figure 3).
The initiation of a biologic agent also resulted in fewer ED visits and hospitalizations. Two patients had an ED visit for an asthma exacerbation since starting a biologic agent and 1 patient had a hospital admission for an asthma exacerbation. No patients were hospitalized in the ICU after starting a biologic agent.
Discussion
The 15 patients in this initial data were referred to the severe asthma clinic by pulmonology, ear, nose, and throat (ENT), primary care, and a hospitalist during an in-patient stay. As the enrollment in our clinic grows, an increasing number of patients are referred from the allergy clinic as well. Patients in the severe asthma clinic also are referred by regional centers as news of the clinic is spread by word of mouth to surrounding VA facilities. As our clinic gains the capacity to serve more patients, we hope to contact WDCVAMC primary care, pulmonology, allergy, and ENT departments to raise awareness of the clinic.
Benralizumab and dupilumab were the most used agents in this preliminary data. This finding was largely due to the ability of patients to self-administer benralizumab, which was particularly beneficial during the COVID-19 pandemic. Of note, 5 patients in this study switched from another biologic agent to benralizumab due to the ability to self-administer. Three of 5 patients that required steroids after initiating benralizumab used fewer steroids than they had previously. This finding suggests benralizumab may be the preferred agent when travel time to health care is a challenge, reducing the need for frequent clinic visits and transportation.
This preliminary data supports previous studies that have demonstrated that biologic agents improve clinical outcomes by reducing asthma exacerbations, OCS use, hospitalizations, and ICU stays for patients on all 4 biologic agents. In addition to improving patient health through avoiding complications of prolonged OCS use and hospital stays, the decrease in ED visits and hospitalizations provides a substantial cost reduction to the health care system.
