Emerging treatments

Macrolide antibiotics

In adults, add-on adjunctive azithromycin is an option in step 5 treatment for persistent symptomatic asthma despite high-dose inhaled corticosteroid (ICS)-long-acting beta agonist (LABA) therapy. Adjunctive therapy with macrolides appears to be safe and effective in children with reactive airway disease.[227] Early administration of azithromycin reduces the risk of severe lower respiratory tract illnesses in children.[228]​ Macrolides are not currently recommended as routine therapy for childhood asthma or viral-induced wheeze.[1][229][230]

Bacterial lysate therapy

Bacterial lysates show promise as add-on treatments for the control of wheezing episodes and asthma exacerbations.[231]​ OM-85 bacterial lysate is associated with beneficial immunomodulatory effects and improvements in lung function in children with asthma.[232] Add-on therapy with OM-85 did not reduce asthma exacerbations in a double‐blind, randomised, placebo‐controlled of adults with severe asthma.[233]

Benralizumab

Benralizumab is a humanised monoclonal antibody that binds to the IL-5 alpha receptor and has evidence of effectiveness from age 6 years as an add-on therapy in patients with severe asthma and an eosinophilic phenotype. Food and Drug Administration (FDA) approval in children aged 6-11 years is based on evidence from an open-label, phase 3 study of benralizumab conducted in the US and Japan.[234]​ Benralizumab has been shown to decrease rates of asthma exacerbations, has a significant corticosteroid-sparing effect, and shows benefits in patient-reported outcomes, health-related quality of life, lung function, and nasal polyposis symptoms.[235][236][237][238][239]​​​

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