Biologics Offer New Relief for Asthma Patients with Long-Term Sinusitis and Nasal Polyps

Biologics are medications made from living organisms that target specific parts of the body. While often linked to cancer care, they’re also used to treat moderate to severe asthma, especially in patients who don’t respond to standard treatments.

WORDS LIM TECK CHOON

FEATURED EXPERT PROFESSOR DATO’ DR BALWANT SINGH GENDEH Senior Consultant Ear, Nose, and Throat (ENT) Surgeon Pantai Hospital Kuala Lumpur

Biologics are a relatively new class of medications that are derived from living organisms. They are designed to target specific components of the body for a more precise treatment compared to older treatments.

While most people associate biologics with cancer treatment, these types of medications are also used in the treatment of moderate to severe asthma, especially for people that do not respond favourably to more standard treatments.

FIRST, LET’S TAKE A LOOK AT ASTHMA

Professor Dato’ Dr Balwant Singh Gendeh reveals that there is a link between asthma and nasal polyps.

When someone has both asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), it means that:

• They are dealing with inflammation in both their airways and sinuses.
• This can make breathing problems worse, cause frequent sinus infections, and make asthma harder to control.

Past studies suggested that the prevalence of people with CRSwNP that also have asthma to be anything from 40% or 60% of total cases.

COMMON MANAGEMENT OPTIONS FOR ASTHMA AND CRSwNP 

• People with CRSwNP are often prescribed steroid nasal sprays to control the growth of their polyps. This can help delay the need of surgery, but the steroids will not remove the polyps.
• Now, people with asthma also need to take inhaled and oral corticosteroids in the form of inhalers.

Hence, someone with both conditions will have to take steroid nasal sprays on top of inhaled and oral corticosteroids.

Professor Dr Balwant emphasizes that while these medications are beneficial and should be taken based on the doctor’s instructions, those that have asthma and CRSwNP could end up with what is called a high steroid load—they have higher than normal levels of steroids in the body.

A high steroid load over long periods of time can cause health issues such as osteoporosis as well as various metabolic and cardiovascular complications.

HOW BIOLOGICS CAN HELP REDUCE STEROID LOAD

This is where biologics could come in and reduce the risk of these side effects.

The usage of biologics can reduce one’s dependency on corticosteroids and thus also reduce their steroid load.

How Do These Biologics Work?

Biologics target specific molecules that are involved in the inflammation of lung airways.

Here are some possible mechanisms. There are a few types of biologics available in Malaysia, however, and actual details may vary depending on the type used.

Mechanism 1

• Targets immunoglobulin E (IgE), a key antibody involved in allergic reactions.
• Binding to IgE keeps IgE from reacting with components of the immune system called mast cells and basophils.
• This reduces allergic reaction and inflammation.

Mechanism 2

• Targets interleukin-5 (IL-5) or its receptor, both of which are needed to activate eosinophils.
• Eosinophils are a type of white blood cells that contribute to inflammation of the lung airways.
• Hence, this biologic inhibits eosinophil activity and hence decreases inflammation and improve lung function.

Mechanism 3

• Blocks interleukin-4 (IL-4) and interleukin-13 (IL-13) pathways.
• These pathways are involved in inflammatory response to allergens.
• Hence, this biologic helps to reduce inflammation and mucus production, thus improving lung function.

Biologics are typically administered via injection or intravenous infusion (‘drip’), often in a healthcare setting.

Professor Dr Balwant personally prefers administration into the abdomen—a pain-free method involving the use of a subcutaneous needle—as this method allows for improved delivery into the circulation system as well as improved active effect of the biologics once they enter the circulation system.

The dosage and number of times one needs to receive their biologics will vary depending on the type of biologics prescribed.

THE ADVANTAGES OF BIOLOGICS

Biologics offer several advantages compared to traditional corticosteroids, which are commonly used to manage asthma.

• Target only specific pathways, so there are fewer side effects.
• Decreases the need for long-term steroid use and hence steroid load; this reduces the risk of side effects associated with high steroid load.
• Many studies indicate significantly reduced severity of asthma attacks, hospitalizations, and emergency room visits.
• Allow for personalized treatment to meet the patient’s unique health needs, based on their symptoms and existing health conditions.

A MULTI-DISCIPLINARY APPROACH TO THE USE OF BIOLOGICS

Professor Dr Balwant Singh Gendeh emphasizes that treatment involving the use of biologics is typically involves a multi-disciplinary approach.

In this case, one would be working closely with an ENT specialist, a respiratory medicine specialist, and a haemotologist. The haematologist—a specialist on health issues involving blood and lymphatic system—will assess the patient’s blood immunoglobin levels to determine how well the biologics are working for the patient.

Reference: Langdon, C., & Mullol, J. (2016). Nasal polyps in patients with asthma: prevalence, impact, and management challenges. Journal of asthma and allergy, 9, 45–53. https://doi.org/10.2147/JAA.S86251