“Let’s be fire preventers, not just firefighters,” says asthma expert Simon Couillard, emphasizing the importance of early intervention.

Early diagnosis and treatment can transform the lives of many asthma patients. “Simple tests can reveal who is at high risk. If we intervene early, we can prevent severe attacks and, in some cases, even achieve remission,” says Canadian asthma expert Simon Couillard.

Lars Brock Nilsen Lars Brock Nilsen Lars Brock Nilsen Journalist

Casper Lorentzen Casper Lorentzen Casper Lorentzen Journalist

Publisert 02.10.2025 - 13:27 Sist oppdatert 02.10.2025 - 13:27

Simon Couillard, Canadian senior physician and expert on asthma and early intervention.

Asthma – a Heterogeneous Disease

Asthma is not a single disease but a complex and varied condition, says Couillard, who is Associate Professor and Clinical Researcher at Sherbrooke University in Canada. He recently took part in an episode of the HealthTalk podcast during a visit to Norway.

“Asthma is often treated with a one-size-fits-all model, but this means some patients receive unnecessarily aggressive treatment, while others get the right treatment far too late. That has to change,” he says.

According to Couillard, today’s diagnostic methods are both cumbersome and inadequate, leaving many patients either misdiagnosed or undiagnosed for long periods.

Inflammation Is the Key

Couillard highlights airway inflammation as a decisive risk factor. His research shows that two simple tests – a blood test for eosinophils and measurement of exhaled nitric oxide (FeNO) – can identify patients at high risk of severe asthma attacks.

“We now know that inflammation is a key factor. And the good news is that it can be treated – with inhaled corticosteroids or biologic drugs. By using these tests, we can predict risk and treat it early. This is the ‘predict-and-prevent’ principle in practice,” he explains.

Mild Asthma Is Not Harmless

Many people with mild asthma are still treated only with an inhaler, which relieves symptoms but does not reduce inflammation.

“Patients with mild asthma can also suffer severe attacks, especially if they have high inflammation. That’s why everyone should have access to as-needed anti-inflammatory treatment. Some patients should quickly be put on a fast track to a specialist, while others can be managed safely in primary care,” says Couillard.

Biologic Drugs – and the Future

Biologic medicines have already revolutionized treatment for patients with severe asthma. Many experience far fewer attacks and, in some cases, regain an almost normal life. But Couillard believes the potential is even greater:

“The question is whether we can start earlier, before the damage has been done. With the right patient selection, this could be both effective and sustainable.”

He believes the coming years will see more biomarker-based diagnostics, more targeted therapies, and broader biologic medicines that block multiple signaling pathways simultaneously.