RASP-UK - Moving away from the ‘one size fits all’ approach to treatment in severe asthma

The RASP-UK Consortium is a large scale research project that aims to target treatments effectively in patients with severe asthma

Difficult to treat asthma affects up to 20% of patients with asthma in the UK despite currently available therapies and is associated with significant healthcare cost. Treatment guidelines advise the ‘step wise’ increase of corticosteroids but the response is often poor as this “one size fits all” approach does not benefit all patients. Characterising a patient’s response to treatment will help our understanding of non-response and will aid development of new drugs for severe asthma.

The RASP-UK Consortium brings together a partnership of clinical and academic excellence from UK Universities and NHS Severe Asthma Centres, together with the Pharmaceutical Industry. Our primary focus is to target corticosteroid treatments more effectively and to understand why some patients do not respond to corticosteroids. Our industry partners are developing new treatments for severe asthma that will be tested in these patients and asthma ‘biomarkers’ will be identified to predict response to these new therapies. Two approaches will initially be used to differentiate between patients who respond and do not respond to corticosteroid treatment, as follows:

  1. In some patients with difficult to treat asthma, the problem is non-adherence, whereby patients, intentionally or non-intentionally, do not take their prescribed corticosteroid treatment. This is common and is poorly recognised by doctors. This can result in patients being inappropriately labelled as having 'corticosteroid resistant' disease. Assessing adherence objectively is a pre-requisite to optimising corticosteroid therapy. The Consortium programme will assess adherence using remote monitoring technologies and non-adherent patients will be assisted and managed within their clinical service.
  2. Some severe asthma patients have inappropriate increases in corticosteroids in the absence of corticosteroid responsive inflammation, and this can lead to harmful side-effects. Our Consortium will validate a new way to optimise corticosteroid therapy using simple tests of corticosteroid response. We know that patients with low measures of certain asthma biomarkers have a low chance of having an asthma attack and we can safely reduce and optimise their corticosteroid treatment dose.

This approach of corticosteroid treatment optimisation will identify two populations of severe asthma patients, with different patterns of lung inflammation, one with corticosteroid responsive disease which we call "T2-High"severe asthma and the other with corticosteroid unresponsive disease or "T2-Low" severe asthma. The T2-High group will be available for clinical trials of new treatments which have already been developed by the Pharmaceutical Industry. We currently understand much less about the T2-Low group, so these patients will be studied intensively to help us identify new drugs for this group. They will then be able to enter trials to test these new drugs.

This ambitious programme is the first to take this type of approach in severe asthma, specifically to assess objectively adherence to current treatment, and then to test a way to optimise corticosteroid therapy. It will provide a world-leading step change in the care of patients with severe asthma. It will also enable a clinical trials programme to be expanded within the UK Severe Asthma Clinical Centres to allow the safe and targeted testing of new treatments.

The RASP-UK Consortium will provide a world leading change in the care of patients with severe asthma.