Patient Introduction

Hello, my name is Victoria, but everyone calls me Vicki. I'm 34 years old. I've had eczema and allergies as long ago as I can remember; my first allergy was to cow's milk as a young child, although I was told that I "outgrew" it. As a preteen I developed more allergies, which caused really unpleasant late-summer symptoms mainly a constantly runny nose and very itchy, red, tearing eyes treated with an antihistamine. I pretty much "outgrew" that too, but in my early twenties I began to experience episodes of wheezing. My doctor diagnosed me with asthma and prescribed a rescue inhaler and inhaled steroids, which helped me. But these episodes occur more frequently now. Three months ago, I had to go to the ER for the first time in years because the wheezing wouldn't stop, which was scary. My breathing hasn’t improved much since, even though I have been on steroid pills and a new long-acting inhaler since that episode; I have wheezing almost every day now. I’m worried that I will have to be on steroids indefinitely, and I still haven’t been able to resume my normal activities.

Question #1

Do you feel like your asthma symptoms have improved at all since starting the steroids? And have you considered going back to the ER since your last visit?

Answer

Question #2

That certainly is more frequent and severe than your previous symptoms. Have you noticed any triggers, such as certain environments or activities, that seem to set off your asthma attacks?

Answer

Question #3

Those are some important triggers! When you feel an asthma attack coming on, how do you think your current medication is helping to control your symptoms?

Answer

Question #4

Can you walk me through how you typically use your inhalers? And do you use a spacer?

Answer

Question #5

Hmmm; I'm also concerned about how your symptoms have progressed. Especially because your most recent lung function test showed the amount of exhaled air over one second was below normal. Have you had any recent bloodwork?

Answer

Question #6

High eosinophils are connected with airway inflammation called type 2 inflammation, which can be associated with worsening symptoms in asthma. Allergies can also increase eosinophils. These findings can help us pick a possible treatment target; have you heard of biologics?

Answer

Question #7

Possibly - biologics are injectable drugs that suppress type 2 inflammation. Several are approved for moderate-to-severe asthma, and one in particular helps since you need oral steroids.

Answer

Question #8

The first biologic was approved for asthma in 2003 and there have been several approved since then. There’s lots of good data on them, concerning both safety and efficacy. Would you ever consider this type of treatment?

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Question #9

Biologics often reduce exacerbation rates and improve lung function, providing greater asthma control. However, not everyone responds the same, so we will monitor how you do.

Answer

Question #10

You would still need your current inhaler regimen, but perhaps at lower doses and even less often for rescue medications over time. You may even be able to reduce or eliminate the oral steroids; this will depend on how you respond.

Answer

This activity is provided by Med Learning Group.
This program is supported by an independent educational grant from Regeneron Pharmaceuticals, Inc. and Sanofi.
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