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Severe Asthma Research

Severe Asthma Research: research to aid the development of novel precision medicine therapies

Key Objectives

In recent years, the treatment options for severe or uncontrolled asthma have been rapidly increasing, especially pertaining to novel biologic therapies. Although biologic therapies may improve asthma symptoms, exacerbation rates, and lung function parameters, they have not been shown to modify the disease process or provide lasting benefits after discontinuation. The severe asthma working group was formed to focus on 2 key objectives:

  • Insight into how severe asthma develops in patients and learning about the biological mechanisms that lead to different types of asthma
  • Informing the development of new therapies for earlier intervention in asthma patients prior to lung function decline

This research theme/project has been prioritised by a group of professionals in the asthma field as an area of scientific uncertainty that cannot be readily resolved by a competent professional, with novel features. The R&D requirements have been met as follows:

R&D Requirements
Objectives To overcome the scientific challenge of understanding the trajectory to severe asthma and potential earlier intervention options with new biologic therapies

  • Informing the development of new therapies for earlier intervention in asthma patients prior to lung function decline and severe asthma diagnoses
  • Facilitate the phenotyping and endotyping of patients with severe asthma such that these patient groups can be understood and new therapies and tools developed
Novelty or technical risks This is deemed a novel project the first of its kind in Singapore in relation to the modification and/or development of new biologics based on acquiring new knowledge in relation to earlier interventions.
SIE Studies/experiments in field of science SIE study conducted to obtain new insight on severe and uncontrolled asthma:

Research Activities (SIE Study)

The ongoing research activities of the severe asthma group include a series of planned activities to test or find out something that is not known or readily deducible in the field of severe asthma and biologic therapeutics which will enable the group to develop new novel therapies and novel tools to identify patients suitable for such therapies The following SIE studies identified by the group will provide outcomes that cannot be known or determined prior to the commencement of the study because the knowledge, information or experience to achieve the outcome is not reasonably available:

Activity 1: What is the impact of exacerbation burden on lung function trajectory in a broad as well as severe asthma population?

Severe asthma exacerbations have been reported to be associated with declining lung function. There is a need to examine this association in a real-life asthma population to devise early intervention plans. This project will examine the relationships between exacerbation burden and lung function trajectory using records from ISAR. This project will also explore the optimal time for therapeutic interventions to reduce lung function decline and new or improved biological therapeutics to address the optimal timing. This activity will inform the modification and potential approach to new biologic therapies.

Activity 2: Onset of asthma in severe asthma patients:

The age of onset of asthma is a central factor in characterising the phenotypes of the disease, i.e. asthma with different age of onset shows differing clinical and pathological characteristics. This project will characterise the distribution of age of severe asthma onset and define a cut-off age which can distinguish between phenotype groups. Subsequently, we will describe and compare the demographic and clinical characteristics of early vs late-onset adult severe asthma and identify new therapies which can address these phenotypes. This activity will inform the modification and potential approach to new biologic therapies.

Activity 3: Define an international consensus-based definition of a ‘super-responder’:

Response to biologic therapies in severe asthma patients is often varied. Patients can be broadly classified into 3 groups: non-responders, responders and super-responders. However, a clear definition for super-responders does not exist. This study therefore aims to survey health care professionals who treat severe asthma across a wide range of countries to establish a definition for this term.

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