Tatsächliche Güte der Asthmaeinstellung und Möglichkeiten der zukünftigen Therapieoptimierung

Zusammenfassung

Trotz diverser Bemühungen wie Patientenschulungen, Lungensport und der Implementierung von Behandlungsleitlinien und -pfaden zeigen alle epidemiologischen Studien, dass nur ein kleiner Teil der Asthmapatienten die Kriterien der vollständigen Asthmakontrolle erfüllt. In Abhängigkeit vom Schweregrad scheinen mitunter weniger als 50 % aller Patienten wirklich kontrolliert zu sein. Individuelle Behandlungspläne, eine gute Arzt-Patientenkommunikation, die Fokussierung auf die Symptomenkontrolle und die Verbesserung der Lungenfunktion sind die Eckpfeiler eines guten Patientenmanagements. Eine große Bedeutung kommt in diesem Zusammenhang der Verbesserung bestehender und der Entwicklung neuer Medikamente und damit auch Inhalertypen zu. Tiotropium wurde als erstes langwirksames Anticholinergikum Ende 2014 zur Asthmatherapie zugelassen. Neue Kombinationsprodukte, die ein inhalatives Kortikosteroid und ein β2-Mimetikum enthalten, sind oder werden in absehbarer Zeit zugelassen. Schwerpunkt neuer Entwicklungen sind Substanzen, mit denen zielgerichtet die Entzündung gehemmt werden kann. Dies geschieht mit monoklonalen gegen z. B. Interleukine, andere Entzündungsmediatoren oder Rezeptoren gerichteten Antikörpern, wie Mepoluzimab, Daclizumab und Reslizumab, oder Antisense-Oligonucleotiden. In der Summe werden dem Arzt also in naher Zukunft viele neue Möglichkeiten an die Hand gegeben, die Qualität der Asthmakontrolle zu verbessern.

Abstract

Despite health initiatives and extensive guideline efforts for advancing the management of asthma, evidence from epidemiologic studies suggests, that many asthma patients still have uncontrolled disease. The percentage of the uncontrolled disease stage is highly prevalent and eventually succeeds the 50 % range depending on the disease severity. There is urgent need for improved care particularly in moderate as well as in severe asthma. Implementation of treatment plans, the focus on symptom control, better patient-caretaker communication and most importantly improvement of specific treatment options are the cornerstones for success. Tiotropium, the first long-term antimuscarinic compound, was approved for asthma treatment in 2014, new developed inhaled corticosteroids as well as β2-mimetics and inhaler types will enhance the physician’s armamentarium to treat this disease better. Agents aimed at inhibiting cytokines, such as mepoluzimab, daclizumab, reslizumab and others hold to various degree promise in the treatment of asthma. Other agents under investigation include phosphodiesterase type 4 inhibitors and oligonucleotides. In summary, there is future promise for substantial therapeutic advances in moderate and severe persistent asthma.

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