Deconstructing Difficult-to-Treat Asthma in the Age of Targeted Biologic Therapies

Deconstructing Difficult-to-Treat Asthma in the Age of Targeted Biologic Therapies

Med-IQ Select
Expiring Soon
Online Course | Specialties: Allergy and Immunology, Pulmonary Disease
Released: 9/30/2020
Expires: 9/29/2021
Max Credits: 1.0
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Geoffrey Chupp, MD
Professor of Medicine (Pulmonary)
Director, Yale Center for Asthma and Airways Disease
Director, Pulmonary Function Laboratory
Yale School of Medicine
Yale-New Haven Hospital
New Haven, CT

Michael Wechsler, MD
Professor of Medicine
Director, The Cohen Family Asthma Institute
National Jewish Health
Denver, CO
Activity Planners
Lori Pender, PharmD, MPH
Manager, Educational Strategy and Content
Baltimore, MD

Lisa R. Rinehart, MS, ELS
Director, Editorial Services
Baltimore, MD

Samantha Gordon, MS
Accreditation Manager
Baltimore, MD

Amy Sison
Director of CME
Baltimore, MD

Jessica Martin, PhD
Martin Medical Writing, LLC
Saint Paul, MN
Learning Objectives
Upon completion, participants should be able to:

  • Identify patients who may benefit from available biologic therapies utilizing available tools to assess asthma severity, control, phenotype, and endotype
  • Identify the inflammatory mechanisms and pathways that underlie the pathobiology of asthma, their clinical effects, and their utility as therapeutic targets
  • Evaluate currently available targeted biologic therapies in terms of safety, efficacy, mechanism of action, and place in personalized treatment plans for patients with moderate-to-severe asthma

Target Audience
This activity is intended for physicians, nurse practitioners, physician assistants, nurses, and fellows in pulmonology, allergy, and immunology who are involved in the management of patients with moderate-to-severe asthma.
Statement of Need
Despite a constellation of common symptoms, asthma is a heterogeneous disease that arises from multiple disease mechanisms. Identifying the underlying pathophysiology, or disease endotype, that leads to airway inflammation and remodeling is critical when managing patients with severe disease because there are now several targeted biologic therapies available for add-on maintenance use. It is critical that clinicians who care for these patients understand how to diagnose severe asthma and how to use biomarkers and other patient- and disease-related factors for optimal treatment selection.

Providership Statement
Provided by Med-IQ. 
Accreditation/Designation Statements
Med-IQ is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Med-IQ designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CME MOCSuccessful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

CLAIMING MOC POINTS: If you intend to claim MOC points for your participation, you will need to provide your unique, six-digit ABIM ID Number. Please note, your name, ABIM ID number, birthdate and completion status will be shared with ABIM through the ACCME PARS system. Your points will be automatically submitted to the ABIM on your behalf; please allow 4 weeks for your points to display on the ABIM website.

Nurse practitioners, physician assistants, and other healthcare professionals who successfully complete the activity will receive a Statement of Participation indicating the maximum credits available.

Medium/Method of Participation
This is a 1.0-credit CME activity. To receive credit, read the introductory CME material, complete all of the modules, and complete the evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly.

Initial Release Date: September 30, 2020
Expiration Date: September 29, 2021
Estimated Time to Complete This Activity: 1 hour

Disclosure Policy
Med-IQ requires any person in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as those in any amount occurring within the past 12 months, including those of a spouse/life partner, that could create a conflict of interest (COI). Individuals who refuse to disclose will not be permitted to contribute to this CME activity in any way. Med-IQ has policies in place that will identify and resolve COIs prior to this educational activity. Med-IQ also requires faculty to disclose discussions of investigational products or unlabeled/unapproved uses of drugs or devices regulated by the US Food and Drug Administration.

Drug/Product Usage by Faculty
Off-label/unapproved drug uses or products are mentioned within this activity.

Disclosure Statement
The content of this activity has been peer reviewed and has been approved for compliance. The faculty and contributors have indicated the following financial relationships, which have been resolved through an established COI resolution process, and have stated that these reported relationships will not have any impact on their ability to give an unbiased presentation.

Geoffrey Chupp, MD
Fees received for promotional/non-CME activities: AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Genentech, GlaxoSmithKline, Regeneron, Sanofi Genzyme, Teva Pharmaceutical Industries Ltd.

Michael Wechsler, MD
Consulting fees/advisory boards: AstraZeneca, Cohero Health, Equillium, Inc., Genentech, GlaxoSmithKline, Novartis Pharmaceuticals Corporation, Regeneron, Sanofi-aventis U.S. Inc., Sentien Biotechnologies, Inc., Teva Pharmaceutical Industries Ltd.
Contracted research: AstraZeneca, Regeneron, Sanofi-avenis U.S. Inc., Teva Pharmaceutical Industries Ltd.

The writer, peer reviewers, and activity planners have no financial relationships to disclose.
Statement of Evidence-Based Content
Educational activities that assist physicians in carrying out their professional responsibilities more effectively and efficiently are consistent with the ACCME definition of continuing medical education (CME). As an ACCME-accredited provider of CME, it is the policy of Med-IQ to review and ensure that all the content and any recommendations, treatments, and manners of practicing medicine in CME activities are scientifically based, valid, and relevant to the practice of medicine. Med-IQ is responsible for validating the content of the CME activities it provides. Specifically, (1) all recommendations addressing the medical care of patients must be based on evidence that is scientifically sound and recognized as such within the profession; (2) all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection, and analysis.
Med-IQ is not liable for any decision made or action taken in reliance upon the information provided through this activity.
Contact Information
For questions or comments about this activity, please contact Med-IQ. Call (toll-free) 866 858 7434 or email

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The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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Acknowledgment of Commercial Support
This activity is supported by an educational grant from Sanofi Genzyme.
© 2020 Med-IQ, Inc.


Here are the key takeaways from this activity. Deeper insights and evidence, plus an opportunity to receive credit, are available by clicking the "Continue" button below.

  • Severe asthma is defined as uncontrolled asthma despite optimal therapy and appropriate management of comorbidities; it affects up to 10% of adults with asthma
  • It is now broadly classified into 2 distinct endotypes based on the level of Th2-mediated inflammation:
    • T2-high asthma is driven first by epithelial alarmins, including IL-25, IL-33, and TLSP, then by Th2-cytokines, namely IL-4, IL-5, and IL-13, and may include either a robust eosinophil or allergic response
    • In contrast, T2-low asthma is driven by Th1 and Th17 cells, IL-6, IL-8 and IL-17, and a neutrophilic or paucigranulocytic response
  • Targets for biologic therapy for T2-high asthma include IgE, the IL-5 signaling pathway, and the IL-4R
    • Omalizumab targets circulating IgE
    • Mepolizumab and reslizumab target circulating IL-5
    • Benralizumab targets the α subunit of the IL-5R
    • Dupilumab targets the α subunit of the IL-4R, which is involved in IL-4 and IL-13 signaling
  • Clinically relevant biomarkers for selecting a biologic agent include serum IgE level (omalizumab), blood eosinophil level (all 5 agents), and fraction of exhaled nitric oxide or FeNO (omalizumab and dupilumab)
  • Patients with OCS-dependent asthma are also considered to have T2-high asthma; dupilumab is approved for this indication, and other biologics have demonstrated efficacy in such patients as well
  • Currently no targeted therapies are approved for T2-low asthma; tiotropium, macrolide antibiotics, bronchial thermoplasty, and/or low-dose OCS may be considered

View reference list.

Click "Continue" to proceed through this activity and/or receive credit. To receive credit and a certificate, you must complete all of the modules in this activity.

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The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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