With spring, eight departments of Occitania have just switched to “red” in a high risk of allergy to pollens. With potential cascading consequences: allergies are the cause two times out of three, in a person who suffers from asthma, a pathology that affects more than 4 million French people, and 425,186 patients in Occitanie, including 11,176 with asthma. severe. Fifteen university hospitals have a dedicated consultation in France, including the Toulouse and Montpellier university hospitals in Occitanie.
Professor Alain Didier is a pulmonologist at the Toulouse University Hospital. He invites us not to trivialize the first asthma attacks.
Professor Alain Didier is a pulmonologist at the Toulouse University Hospital. DR PHOTO
With spring, the risk of allergies is higher, and allergy is the cause, two out of three times, when you suffer from asthma…
Yes, a good two-thirds of asthmatics have an allergic support. It does not mean that allergy explains everything, but it contributes, quite often, to aggravate asthma, especially when people are exposed to pollens. For mites, it’s a little more complicated because it’s a less “noisy” exposure than pollens, which can be a permanent nuisance.
And what proportion of allergic people is asthmatic?
Luckily not all of them! About 30% to 40% of patients with allergic rhinitis, the most common form of allergy, will at some point have asthma.
Allergies in France. Sources: RNSA pollens.fr – Public Health France – sante.gouv.fr – asthma-allergies.org
Severe asthma, on which you are raising awareness, is asthma that degenerates for lack of care, or is it a completely different phenomenon?
Severe asthma is thought to be a particular trajectory. Patients have markers of inflammation that are much higher than the others, and are quite severe quite quickly, it’s not progressive. this is why we insist on the need to identify them so that they can benefit from modern treatments and avoid long-term corticosteroid treatments which cause many side effects.
Beyond three courses of high-dose corticosteroids, we eventually have metabolic and cardiac problems…
To protect themselves from a crisis, do people take corticosteroids all year round?
Yes. There are people who take it every day, and others who, because they have very frequent attacks, take large amounts several times a year. And we know that beyond two to three courses of high-dose corticosteroids, we eventually have metabolic and cardiac risks…
Are there any side effects?
Yes, there are also fears of triggering diabetes and osteoporosis linked to this corticosteroid therapy.
How would you qualify severe asthma?
Asthma is described as severe in people who have symptoms every day, despite the recommended background treatment, by inhalation, or in people who have very severe attacks more than twice a year that require them to go to the emergency room or take high doses of corticosteroids to ease the crisis. More than twice a year, it’s a warning sign.
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And a serious crisis is not insignificant…
No, there are people who have crises so serious that they can arrive in intensive care, intensive care, put themselves in danger.
You mention a phenomenon less well known to the general public, the role played in these crises by a particular type of cell, eosinophils.
These are blood cells that are also involved in allergies. And we realized that when you have severe asthma, in 80% of cases, these eosinophils are much more present in the blood or in the bronchi, or in both. Eosinophils are species of bombs that are capable of secreting inflammatory mediators. It was found that they played a very important role in the severity of asthma.
How do we spot them?
They are measured in the blood. But when people take corticosteroids long term or when they have just taken them, the measurement can be distorted.
How are these results used?
When you have a diagnosis of severe asthma, the fact of having increased eosinophils indicates that you can benefit from certain effective treatments, and in particular reducing cortisone, which is a chance. There are treatments that cut off the contact of these eosinophils.
“Cortisone may once have been the solution, it’s not anymore”
People who suffer from severe asthma are not all diagnosed, why?
There are many reasons, starting with the fact that asthma is a bit trivialized. When you are asthmatic, often in your family you have other asthmatics and you consider it somewhat normal to have asthma. We don’t think there can be other therapeutic solutions and we’ll just take cortisone. It may have been the solution in the past, but it isn’t anymore.
And sometimes, we consider that corticosteroid therapy is so effective that we do not take care to count the number of prescriptions. And finally, people tend to self-medicate, they don’t go to consult.
What are the current treatments?
There are always inhalation devices, and when that’s not enough, now we can have recourse for four to five years to biotherapies, which also exist in other inflammatory diseases.
When you have asthma with eosinophils, they are generally very effective. They make it possible to eliminate the symptoms in times of crisis.
What are these biotherapies?
It is often monoclonal antibodies that will block eosinophils. These are targeted treatments, applied in prevention. Side effects are reduced.
One can hope in the long term for very prolonged remissions or cures
What will tomorrow’s treatments look like?
Currently, biotherapies are injected every fortnight, every month or every two months. Tomorrow it will be every six months or every year. Eventually, we can hope that some patients will be in very prolonged remission or cured. They can be prescribed from the age of 12.
Can you be asthmatic at any age?
Many asthmas start in childhood, fortunately, they are far from being all severe. And a second series of asthma starts in adulthood, often between 30 and 50 years old, some can have a very severe profile.
What are the patients you follow telling you?
Each case is almost unique. These people with severe asthma often have a lot of comorbidities, they sometimes have obesity. You have to take patient by patient and there is a lot of emphasis on the need to rehabilitate them to exercise, very often they no longer do physical activity even though it has anti-inflammatory effects. We have spectacular testimonies of people who come to life once more. It is a disease that is often considered inevitable, while great progress has been made.
If you have any doubts, it’s worth making an appointment, even far away, with a pulmonologist or an allergist, to have your breath measured and see if there are any new treatments. There are more and more people with allergies, the number of people with asthma seems to have stabilised, but what worries us a bit is that it seems that the proportion of severe asthmatics is tending to increase.
