Severe asthma: Limitations of the drug program

How many people in Poland struggle with a severe form of asthma, and how many of these people would qualify for biologic treatment?

According to epidemiological data, about 32,000-38,000 people in Poland suffer from severe bronchial asthma. There are currently more than 3,000 patients in the drug program, which has been available for 10 years (of course, it has been a huge success, as it gives us access to the latest therapies). Taking into account the very precise epidemiological data, it seems that this is only 10 percent of the population that meets the criteria for inclusion in the drug program and is cared for according to the most modern, international standards of therapy.

And what are these inclusion criteria?

The inclusion criteria are complex and quite extensive. First, of course, is severe asthma, which we define as needing high doses of inhaled medication, inhaled corticosteroids plus another controlling medication. Despite this, the patient has uncontrolled disease, which is defined as a form where we see frequent exacerbations, meaning the patient requires emergency room visits, hospitalizations and unscheduled doctor visits, systemic steroid administration, with the consequence of this type of treatment. Of course, this places a burden on the patient, his family, and the health care system in terms of the cost of hospitalization and medications, but also the indirect costs of sickness absence, sick leave. It is worth recognizing these severe forms of the disease and implementing optimal treatment, because it pays off from the payer's point of view.

Is treatment in Poland in line with European standards?

What we have at our disposal are global standards (which are described by the acronym GINA), updated annually, presenting the latest evidence-based medical knowledge. In fact, in Poland, we practically have access to most of the drugs written in the GINA standards. In 2022, more than a year ago, a monoclonal body, used for severe asthma, was added to the standards. It is not yet available in Poland, but work on it is underway. We hope that in the coming months it will be made available to our patients in Poland.

Severe asthma is a life-threatening disease, often leading to death. How could increasing access to biologic treatment in outpatient specialty care, or at home, improve the quality of asthma treatment in Poland and the quality of life of patients?

We have already said that severe asthma affects a few percent of the population of all asthma patients. This is a very small group. It is estimated to be about 3, 4, 5 percent. But these patients consume about 80 percent of the cost of care for bronchial asthma patients in general. This shows the scale of the problem. We know that the inclusion of modern therapies definitely changes the control of the disease. We see a decrease in the number of exacerbations, hospitalizations, unscheduled medical visits, a decrease in the need for systemic steroids. These patients are returning to normal functioning, study or work. They can perform activities of daily living normally. This is a huge success, a breakthrough. Until now, there were no drugs that could change this. Given the latest research, we know that biological treatment changes the natural history of the disease. It can induce remission for us, which we describe as a patient's return from the most severe degrees of bronchial asthma to milder, first- and second-line treatment, where we can definitely reduce the intensity of therapy. So this is a huge breakthrough. The goal of treatment, of course, is good control of the disease. When we achieve good control, such a patient does not need to be hospitalized under the drug program. He can be issued a drug to take home. These are drugs that are very easy to administer (their formulation is prepared for this i.e. it comes in the form of auto-syringes or injectors that are easy to administer at home). And indeed, such administration at home relieves the patient of the logistical aspects, of traveling to the center. It also relieves the burden on the patient care system, because it is the centers that provide care that monitor, but, when it is actually necessary. If good disease control is achieved, the frequency of these visits could actually be reduced. It is worth mentioning that the current drug program unfortunately does not allow for such a treatment regimen. It's not written into the drug program's funding conditions, which is a huge limitation of the program.