First new asthma attack treatment in 50 years | Hacker News Reader

First new asthma attack treatment in 50 years

bbc.com

38 pointsbookofjoe22 comments

The title is misleading, bordering on being a lie. There is Omalizumab which works wonders for allergic asthma. As the -mab indicates, both are the same class of meds (antibodies that disable specific parts of your immune system). While this new one apparently targets eosinophils, Omalizumab targets IgE antibodies, thereby suppressing the part of the immune system that is responsible for allergies and allergic asthma.

The issue with this class of meds is that they are unfortunately prohibitly expensive. 400€ for a single shot, and you may need up to to 6 per month, for the rest of your life. The new one likely won't be cheaper, all the -mab are that expensive. In large part because they are also very difficult to produce (you need to cultivate cells that produce these antibodies) so it's difficult for competition to enter the field.

I think the difference is between persistent asthma, and asthma attacks- for example, I have two different asthma meds, one of which is intended for acute asthma (when you're having an attack) and another which is intended to chronic asthma (the ongoing, persistent symptoms).

On mobile so I can't dig into it, but from what german wikipedia says it's applied the same way as Omalizumab - as a subcutane depot, which in case of Omalizumab gets slowly absorbed over the course of weeks.

> As the -mab indicates, both are the same class of meds (antibodies that disable specific parts of your immune system).

Might be more clear to say -mab indicates _monoclonal_ antibodies, _engineered_ for specific purposes, in this case such as interfering with an over-amplified immune response.

I knew they were called monoclonal antibodies but I didn't realize mab is the short for that until your post, haha.

Based on my spotty but self-interested knowledge of medical history, we make new immune related drugs for mostly three reasons: one, microbes have adapted and we need to alter the chemical to still be effective (see also quinine and pyrethrins), two, to simplify production (yew trees vs lab made Taxol), or more cynically, to get a new patent on a drug and keep making money after you’ve run the initial patent and the time released variant clocks out (I absolutely hate that that’s a thing).

So while it’s not surprising that a new flavor in a class of drugs is also expensive, it’s not a foregone conclusion. A new catalyst or a less tricky bond to force could make a drug that works as well or almost but is much cheaper to make.

I was diagnosed with asthma in my mid 40s after my first major attack. "Your lungs are those of an 84 year old". After dealing with standard treatments and the side effects for a while, I started searching and found something.

Magnesium (200mg) and Iodine (1mg). After several months on just that: "Your lungs are better than average for your age".

Your mileage may vary. I doubt there is one size fits all solution, but this has served me well for years.

Did you get any tests after standard treatment and before taking Magnesium and Iodine? Is it possible that the standard treatment worked well, even if it had side effects? I am just a curious ignorant layperson.

The standard treatment was working but had side effects. It's also something you have to do for the rest of your life, which is why I wanted to stop it. I was off that and on my other stuff for at least 3 months before testing my new normal.

Which salts of those minerals specifially do you take?

Magnesium glycinate - more recent because glycine is good for you too.

I started with kelp tablets for the iodine 150mcg x6. But not I just use Lugols solution in my morning caffeine drink.

What kinds of magnesium and iodine did you use? Do you live in a goiter belt?

1mg == 1000 micrograms. RDA for iodine is about 150mcg for teens and adults, 220mcg for pregnant women and 290mcg for lactating women. I think the Japanese diets contain 1000-3000mcg (1-3mg).

RDA for Iodine is kind of low. The upper limit is actually quite high and the Wolff-Chaikoff effect seems to be either temporary or not even real. But have your thyroid checked if you're going to supplement Iodine just to be sure.

My understanding is the RDA is the bare minimum to avoid obvious symptoms of deficiency, and that everyone does better with 500 to 1000mcg. I think there's a case to be made for being cautious about getting too much supplemental iodine - I've read reports on /r/iodineprotocol of people who started taking mega-doses and aren't doing so well.

I take 400-600mcg of iodine every other day. This is 2-3 drops in water. The carrier is ethanol. Pure iodine doesn't dissolve in water, so the drops become a cloud when dispensed into water.

Given how prevalent Asthma is among the western population, this is exceptional news. (1-in-10 to 1-in-5, according to the CDC).

Is anyone better versed on the causes, though? Prevention is better than cure after all- and much better than just treatment.

I’m curious if something in our environment is causing this, because you would presume that natural selection would have run its course on us, as without treatment I would certainly not have made it into adulthood.

It's multifactorial. Lung (and all respiratory) epithelial tissue is amazingly delicate for something exposed to the open air.

It is an immune system overreaction causing inflammation causing then bronchial constriction and of more ramified aereal ducts reducing total air vol per breath. Inmune causes are routinely tested to be of allergic origin for external allergens and a test panel is common to be done measuring reaction to agents such as dust mitels, pollen, animal fur. Often one cannot pin a single cause. Bad air quality (smog) or cold can be triggrers, and contradictorially unusual physical effort demands can trigger it reducing O2 availability just when more is what the situation demands. It's a self-immune problem in the end, not that well understood.

Cured my asthma with cardio exercise and weight loss.

Western populations are overweight and sedentary.

Correlation isn't causation but seems like that has to be a major factor.

MAB injections are a useful part of the arsenal, but not a new class of drug, and are only a good choice for a subset of sufferers.

I am very frustrated that the research on calcilytics, which look so promising, appear hopelessly and inexplicably stalled. People in academia won't even answer my emails asking why clinical trials aren't proceeding.

I have allergic and eozinophil asthma, mixed. Mepolizumab is a game changer, for me.

Why does the approval of drugs have to be binary?

If the drug shows promising results it should be available with an added disclosure.

You can buy cancer causing cigarettes over the counter but not a drug that has already shown results.

It’s frustrating

I believe it’s because a doctor doesn’t prescribe cigarettes to you. So the only liability is your own.

It’s a weak line of reasoning to _allow_ cigarettes, but I’m not convinced it’s so bad to _disallow_ novel therapeutic uses that are understudied.

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