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    Expert Opinion on Practice Patterns in Mild Asthma After the GINA 2019 Updates: A Major Shift in Treatment Paradigms from a Long-Standing SABA-Only Approach to a Risk Reduction-Based Strategy with the Use of Symptom-Driven (As-Needed) Low-Dose ICS/LABA
    (Current Medicine Group, 2022) Ozseker, Zeynep Ferhan; Aksu, Kurtulus; Mutlu, Levent Cem; Mutlu, Pinar; Ozturk, Can
    Purpose of Review This expert opinion, prepared by a panel of chest disease specialists, aims to review the current knowledge on practice patterns in real-life management of mild asthma and to address the relevant updates in asthma treatment by The Global Initiative for Asthma (GINA) to guide clinicians for the best clinical practice in applying these new treatment paradigms. Recent Findings On the basis of the emerging body of evidence suggesting the non-safety of short-acting beta 2-agonists (SABA)-only therapy and comparable efficacy of the as-needed inhaled corticosteroids (ICS)-formoterol combinations with maintenance ICS regimens, GINA recently released their updated Global Strategy for Asthma Management and Prevention Guide (2019). The new GINA 2019 recommendations no longer support the SABA-only therapy in mild asthma but instead includes new off-label recommendations such as symptom-driven (as-needed) low-dose ICS-formoterol and low dose ICS taken whenever SABA is taken. The GINA 2019 asthma treatment recommendations include a major shift from long-standing approach of clinical practice regarding the use of symptom-driven SABA treatment alone in the management of mild asthma. This expert opinion supports the transition from a long-standing SABA-only approach to a risk reduction-based strategy, with the use of symptom-driven (as-needed) low-dose ICS/LABA in mild asthma patients, particularly in those with poor adherence to controller medications. The thoughtful and comprehensive approach of clinicians to these strategies is important, given that the exact far-reaching impact of this major change in management of mild asthma in the real-world settings will only be clarified over time.
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    No increased risk of severe COVID-19 in asthma treated with biologics
    (Kare Publ, 2022) Beyaz, Sengul; Erecan, Emircan; Mutlu, Pinar; Ozseker, Zeynep Ferhan
    BACKGROUND AND AIM: Biologics can be used safely for patients with severe asthma during the coronavirus pandemic, but there is still a lack of information regarding their effects during SARS-CoV-2 infection. The aim of this study was to evaluate the impact of biologic therapies on the course of SARS-CoV-2 infection and to assess the outcome of COVID-19 for severe asthmatics in pandemic conditions. METHODS: A total of 100 severe asthma patients treated with biologics (7 treated with dupilumab, 22 with mepolizumab, and 71 with omalizumab) were included. Patients' demographic, clinical, and laboratory findings as well as the course of the COVID-19 disease were evaluated. RESULTS: Of the total 100 patients, 15% of patients were diagnosed with COVID-19. There were no significant differences between SARS-CoV-2 positive and negative patient groups in terms of demographic features, atopy, comorbidity, duration of asthma, and duration of biological use. The body mass index (BMI) was higher in the SARS-CoV-2 negative group than the positive group (p=0.005). Asthma exacerbation during COVID-19 was observed in 3 patients, and only 2 were hospitalized for 5 days. SARS-CoV-2 positive group exhibited lower eosinophil and lymphocyte levels when infected with COVID-19 than before COVID-19 (p=0.01 and p=0.0009 respectively). CONCLUSIONS: The rate of COVID-19 infection was higher in patients with severe asthma receiving biologics than in the general population. However, it can be speculated that treatment with biologics may have protection against severe COVID-19 and mortality. Further studies are required to investigate the role of biologic agents, which affect the level and function of eosinophils in viral infections, especially SARS-CoV-2.