Advancing Asthma Management Through Innovation, Access and Equity

Asthma remains a major public health challenge, affecting over 260 million people worldwide — yet many patients, particularly those with mild or intermittent disease, continue to face uncontrolled symptoms and serious exacerbations.

In this Xtalks Clinical Edge Q&A, we speak with Andrew Menzies-Gow, Vice President of Respiratory & Immunology, Global Biopharmaceuticals Medical at AstraZeneca, to explore the future of asthma care.

From shifting treatment paradigms toward disease modification to leveraging digital technologies and advancing health equity, Menzies-Gow shares insights into the scientific, clinical and strategic changes needed to truly transform outcomes for asthma patients around the world.

Unmet Needs in Asthma Care

Despite decades of research and treatment advances, asthma remains a significant public health burden. What do you see as the most pressing unmet needs in asthma care today, particularly for patients with mild or intermittent disease?

Menzies-Gow: The most pressing challenge in asthma is that, despite how many treatments are available and how many people live with it, the disease is still largely uncontrolled for many asthma sufferers.

Let’s take a look at the numbers:

There are approximately 262 million people suffering from asthma, including more than 25 million in the US
Patients with mild asthma comprise at least 50% of the US asthma population
Up to 30% of exacerbations and related deaths occur in patients treated for mild asthma or those with infrequent symptoms.

Current treatments are insufficient. Despite the availability of over 20 maintenance medications, exacerbation rates remain high. About half the patients treated with inhalers remain uncontrolled, and the use of biologics is lagging behind other diseases.

Our ambition is to address this disparity by shifting the treatment paradigm from symptom control to disease modification. By targeting the underlying mechanisms driving disease and inflammation, we hope to prevent disease progression and one day eliminate asthma attacks.

How is AstraZeneca approaching health equity in asthma management, particularly in ensuring access to care and treatment innovations across diverse populations?

Menzies-Gow: Advancing respiratory care is one of the greatest opportunities in healthcare today, and a cornerstone of our strategy. We recognize that access to care and treatment can vary significantly across different populations and geographies, so we’ve established deep local and regional partnerships with an aim of driving earlier diagnosis and intervention and improving patient outcomes.

Through targeted investment, scientific innovation and collaboration, we’re working to transform asthma care globally:

Localized Initiatives: Asthma solutions must be tailored to local needs. In China, we’re aiming to improve diagnosis and treatment and ease pressure on hospitals by building Centers of Excellence and advancing community-based diagnosis and treatment. Currently, we’re piloting a portable oscillometer that could help identify up to 14 million additional asthma and COPD patients by 2030.
Global Partnerships: We partner with healthcare systems, patient advocacy groups and scientific societies worldwide to enhance access to care. In Italy, for example, we partner with FederAsma e Allergie and Respiriamo Insieme, the Italian society of Allergology, Asthma, and Clinical Immunology (SIAAIC) and the Italian Society of Pulmonology (SIP) to host AsmaZeroWeek. The program provides free consultations with specialists to more than 1,000 patients in 35 centers across urban and rural communities in Italy.
Educational Outreach: Our research is expanding scientific knowledge and closing the gap between real-world evidence and clinical practice. Among many global initiatives to support disease education, Project ERASED in Malaysia helps to identify and manage high-risk asthma patients in primary care and provide disease education. To date, we’ve engaged more than 600 healthcare professionals in educational workshops.
Advancing Treatment Guidelines: We are focused on improving asthma outcomes by increasing rates of diagnosis and supporting the implementation of national and international guidelines. As of 2023, the Global Initiative for Asthma (GINA) no longer recommends albuterol alone as the preferred rescue therapy – a shift in more than fifty years of clinical practice. Instead, anti-inflammatory rescue therapy is now recommended as the preferred rescue across all asthma severities. This complements the latest guidelines from the National Asthma Education and Prevention Program (NAEPP) in the US, which supports a rescue approach that aims to treat symptoms and inflammation concomitantly.
Innovative Therapies: Our commitment extends to our R&D efforts, where we are focused on developing therapies that address the full spectrum of asthma severity. By pioneering new treatments that target the underlying causes of asthma, we aim to provide options that are accessible and effective for all patients.

Xtalks Clinical Edge™: Issue 5 — What’s Next in Clinical Innovation for Asthma Care at AstraZeneca

Xtalks Clinical Edge™ is a magazine for clinical research professionals and all who want to be informed about the latest trends and happenings in clinical trials. This magazine immerses you in a world where industry leaders, patient advocates and top researchers converge to provide the most insightful perspectives on clinical trials.

Clinical Trial Landscape

The asthma trial landscape is evolving. What lessons did AstraZeneca learn from recent studies that may inform the future of respiratory trials? How are clinical trial strategies adapting to better reflect the real-world asthma population, including those with mild or undiagnosed disease?

Menzies-Gow: We are changing the way we design and perform our clinical trials to make studies smarter, shorter and more efficient. This includes integrating innovative digital solutions like virtual spirometry, as well as technology advances that enable us to collect data from a patient in their home on a daily or even continuous basis during a trial that is as reliable as the data collected in the clinic.

For example, we recently launched a decentralized study design that allowed participants to accommodate trial-related activities around their daily lives and was intended to remove logistical barriers, thereby lowering participant burden and increasing efficiency and equitable access to the study.

Another example is the AIRE Mobile Unit, a “clinic on wheels” that brings trial screenings directly to patients in diverse communities, eliminating traditional hurdles to clinical trial access. By bringing trials directly to patients in their communities, this pioneering initiative enables individuals to participate, fosters inclusivity and diversifies research.

Strategic Outlook

From a global medical affairs perspective, how do you see the respiratory care evolving — not just for asthma but across other respiratory conditions?

Menzies-Gow: We’re at a critical inflection point. Without change, rising comorbidities, an aging population and overstretched systems will lead to more reactive, emergency-driven care — and more lives lost unnecessarily.

But the opportunity is clear. Chronic respiratory diseases are biologically complex and driven by multiple underlying processes. We take a disease agnostic approach, investigating pathways, connections and mechanisms, with a focus on earlier, more targeted intervention.

Through our in-depth knowledge of these underlying disease drivers, we are working to match patients with treatments most likely to benefit them. This approach could facilitate much earlier intervention with targeted treatment, transforming patient outcomes and changing the course of these diseases.

With targeted investment, scientific innovation and aligned partnerships, we can reshape how we prevent, diagnose and treat — delivering better outcomes for patients across respiratory diseases, like COPD and asthma, and easing pressure on healthcare systems.

What do you think it will take — across research, policy and education — to truly change the standard of care in asthma on a global scale?

Menzies-Gow: Through investment, scientific innovation and deep partnerships across the health ecosystem, we can transform the standard of care, improve patient outcomes and reduce strain on health systems around the world. There is not a “one-size-fits-all” solution in asthma; as patients’ needs expand, multiple lines of therapy are required across primary and specialty care.

We are working with governments, the healthcare community and industry to improve outcomes for people living with respiratory diseases by transforming healthcare delivery and securing prioritization of these conditions. A key area of focus is supporting governments in establishing new or improved national respiratory strategies.

We must abandon the “treatment-failure” driven approach and invest in trials that demonstrate how early intervention can significantly reduce exacerbations, hospitalization and ultimately bend the mortality curve.