Monthly injection helps severe asthma patients reduce or stop steroids - Lancet study

A new report by The Lancet suggests that a monthly injection may help patients with severe asthma safely reduce or even stop daily oral steroid use.

Severe asthma is a form of asthma in which symptoms remain uncontrolled despite high-dose inhaled medications and proper management.  It often leads to frequent attacks, hospital visits, and a heavy reliance on oral steroids to breathe comfortably.

The study published in The Lancet Respiratory Medicine evaluated the effects of monthly Tezepelumab injections on adults living with severe, uncontrolled asthma who had been reliant on daily oral corticosteroids.

Participants in the study received 210 mg of Tezepelumab by subcutaneous injection every four weeks for up to one year.

By the end of the 52-week treatment period, more than half of the participants had completely discontinued their daily oral steroid use. At the same time, nearly 90 per cent had successfully reduced their steroid dose to a low maintenance level.

Importantly, these reductions were achieved without compromising asthma control, demonstrating that Tezepelumab could effectively maintain respiratory stability while minimising reliance on steroids.

Asthma is a long-term condition that affects the airways in the lungs, making them inflamed, narrow, and filled with extra mucus. This makes breathing difficult and can lead to symptoms such as wheezing, coughing, shortness of breath, and chest tightness. Sometimes, these symptoms flare up suddenly, resulting in what is known as an asthma attack.

There are several types of asthma. Allergic, or extrinsic asthma, is triggered by allergens like pollen, dust, pet dander, or mould. Non-allergic, or intrinsic asthma, is caused by factors such as stress, exercise, cold air, viral infections, or irritants like smoke.

Exercise-induced asthma occurs primarily during or after physical activity, while occupational asthma is linked to exposure to substances at work, such as chemicals or dust. Severe asthma is a more serious form that is difficult to control with standard medications and may require high-dose steroids or biologic treatments.

When asthma is not properly controlled, it can be very dangerous. Persistent inflammation and airway narrowing make it harder to breathe, increasing the risk of severe attacks, hospitalisation, and even death.

Uncontrolled asthma can also cause permanent lung damage and reduce quality of life by limiting daily activities, disturbing sleep, and making symptoms harder to treat over time. Proper management is therefore essential to prevent these serious complications and maintain overall health.

The study also highlighted rapid improvements in asthma-related symptoms, lung function, and overall quality of life, with many participants reporting measurable benefits as early as two weeks into treatment.

Over the course of the year, two-thirds of participants did not experience any asthma attacks, suggesting that Tezepelumab not only reduces steroid dependence but also lowers the risk of exacerbations.

This is significant because long-term use of oral corticosteroids is associated with serious side effects, including bone thinning, weight gain, diabetes, infections, and cardiovascular complications. By offering a biologic therapy that can reduce or replace daily steroid use, Tezepelumab provides a safer alternative for managing severe asthma.

The therapy works by targeting thymic stromal lymphopoietin (TSLP), an upstream regulator of airway inflammation, which helps to control asthma at its source rather than just alleviating symptoms.

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Overall, the findings indicate that monthly Tezepelumab injections could transform the management of severe asthma. They suggest that patients who previously depended on chronic oral steroids may now achieve better disease control with fewer health risks.

The study reinforces the potential of biologic therapies to improve long-term outcomes, reduce the burden of medication side effects, and enhance the quality of life for people living with severe asthma.

The study shows that Tezepelumab, given as a monthly injection, could be a game-changer for people with severe asthma who rely on daily oral steroids. The key takeaway is that many patients were able to reduce or even completely stop their steroid tablets without worsening their asthma. This is important because long-term steroid use can cause serious health problems like bone loss, diabetes, infections, and weight gain.

The rapid improvement in symptoms and lung function suggests that Tezepelumab works quickly and effectively to control inflammation in the lungs. By targeting the underlying cause of asthma rather than just suppressing symptoms, the drug provides a safer alternative to daily steroids.

The findings indicate that Tezepelumab could significantly improve the quality of life for people with severe asthma, reduce their risk of steroid-related side effects, and offer a more modern and effective way to manage the disease. It also suggests a shift in asthma treatment toward biologic therapies that treat the root cause rather than relying heavily on steroids.

According to the World Health Organisation (WHO), asthma is a chronic respiratory condition that requires proper management to control symptoms, prevent attacks, and reduce the risk of severe complications.

WHO emphasises that inhaled medications are the cornerstone of asthma treatment, as they deliver drugs directly to the lungs. Inhaled corticosteroids are recommended for long-term control because they reduce airway inflammation, while short-acting bronchodilators provide rapid relief during asthma attacks. Long-acting bronchodilators, often used alongside inhaled steroids, help keep the airways open over extended periods.

For some patients, oral medications may be needed. Leukotriene receptor antagonists help prevent inflammation and asthma symptoms, while oral corticosteroids are reserved for severe flare-ups due to their potential side effects if used long-term.

For individuals with severe asthma that does not respond to standard treatments, the WHO notes that biologic therapies, including Tezepelumab, Omalizumab, Mepolizumab, and Benralizumab, can target specific immune pathways to reduce inflammation and prevent attacks.

WHO also highlights the importance of managing asthma triggers, such as allergens or irritants, and adopting lifestyle measures like avoiding smoke, maintaining a healthy weight, exercising safely, and following a personalised asthma action plan.

Effective asthma management combines appropriate medications, trigger control, and regular monitoring to improve quality of life, maintain lung function, and prevent life-threatening complications.

Globally, the WHO estimates that around 262 million people were living with asthma in 2019. More recent analyses suggest that by 2021, approximately 260.5 million people worldwide had the condition. These figures highlight that asthma continues to be a major health issue affecting people of all ages across different regions.

In Kenya, it is estimated that about 7.5–10 per cent of the population has asthma, which translates to nearly 4 million people. The prevalence varies between urban and rural areas and may be underreported due to limited access to healthcare and diagnostic services in some regions.