In our latest Catalyst interview, Andrew Menzies-Gow, Vice President, Respiratory and Immunology for Global Biopharmaceuticals Medical, AstraZeneca, explores how earlier diagnosis, targeted treatments and system change could redefine respiratory medicine
Interview by Isabel O’Brien
At AstraZeneca, Andrew Menzies-Gow leads global medical strategy across two fast-moving therapy areas, focusing here on respiratory. With a career spanning clinical practice, national policy and drug development, he has been a key player in respiratory care for over two decades, particularly in the field of asthma.
Yet, despite that breadth of experience, his motivation remains strikingly simple. “Sometimes I don’t understand why people would want to do something else,” he says. “Because it’s such an amazing job, and you have such an opportunity to help people.”
That perspective was formed during his clinical career and has carried over into his work in the pharmaceutical industry, where the focus is not just on developing new medicines, but ensuring access remains front and centre. As he puts it: “If the right patient doesn’t get the right medicine at the right time, we haven’t helped people.”
Today, his work spans both respiratory and immunology, and he has a growing interest in how advances such as biologics and cell therapies could shift treatment paradigms. Under his leadership, teams have contributed to global guidelines, delivered major studies and supported access to innovative therapies worldwide.
In this conversation, he reflects on how respiratory care is evolving, why early diagnosis remains a major challenge and what it will take to improve long-term outcomes for patients.
What first drew you to respiratory medicine, and what led you to move from clinical practice into pharma?
I always wanted to be a doctor for many reasons. For one, my parents were doctors and it seemed like a logical thing to do, so I went to medical school and I loved it.
After this, I worked at St George’s Hospital in London where I had two fantastic mentors who were both respiratory physicians. They inspired me to focus on respiratory medicine. Since then, it has always been a passion for me.
When I became a physician in the field, I saw that many treatments were not as good as they could be. The one area where you could really make a difference was asthma because we had some amazing, inhaled therapies even back then. So, I did my PhD around severe asthma and became a severe asthma physician.
After that, I was very lucky with my career. I helped design and deliver clinical trials with pharmaceutical companies. I worked with NHS England to help design care pathways and improve care. But it got to the point where I felt I had done what I wanted to do, and I could do so much more by working within pharma, especially at AstraZeneca which focuses not only on producing medicines but also on transforming care.
Now, what drives me is thinking about how we make people’s lives better. I have seen how transformative it is when someone gets the right treatment. So how do we get more people onto the right drug first time and how do we minimise the side effects of treatments we have used for a long time? Unless we redefine how healthcare is delivered, we are not going to get the right drugs to the right people fast enough.
Unless we redefine how healthcare is delivered, we are not going to get the right drugs to the right people fast enough
How is asthma care shifting beyond symptom control, and what does that look like in practice?
As with every respiratory disease, diagnosis can be a challenge. Ensuring we get the right diagnosis up front is key. At AstraZeneca, we are working with partners to develop new ways to make diagnosis easier.
We are also moving from reactive, symptom-based care to a much more proactive, anti-inflammatory approach. We are targeting airway inflammation as we now understand that there are multiple drivers of asthma. There are millions of people with the disease and each person is different. The concept that one treatment works for everyone is outdated.
Instead, it is about producing the right molecules to target the right part of a patient’s biology. We are now talking about remission. That means preventing future asthma attacks, reducing reliance on medications and preventing loss of lung function over time.
We have also historically relied on oral corticosteroids. These are a great in an acute setting and can save lives, but they have a very significant side effect profile. Cumulative exposure is very damaging and once that damage has occurred it does not tend to reverse. So, reducing steroid exposure is key as well.
Is the perception of COPD as a “challenging” disease with limited optimism starting to change, and if so, why?
COPD is a devastating condition. It is the third largest cause of death in the world, and it drives significant morbidity and mortality. It also leads to significant unscheduled hospitalisation and winter bed pressures for healthcare systems.
That is from a healthcare perspective, but for a person living with COPD and struggling to breathe day to day, it is a truly devastating condition as well.
It is not unreasonable to say that care has at times been nihilistic. There is a lot of stigma associated with COPD. In the lay press it is even described as a “smoker’s disease”, which it often is not. In some parts of the world, other drivers such as biomass fuel exposure play an important role.
Even when we think about people who smoke, this is a disease that develops over decades. Tobacco is very addictive. It is not simply the case that people can just stop smoking. Even if they do stop, people can often still end up with COPD. Regardless, we need to be advocates for the people we are looking after and make sure they get the right treatment.
However, there is more optimism now. Inhaled therapies are improving dramatically. We are starting to see biologic therapies in this space. Better treatments drive optimism and a feeling that we can do better for patients. The more treatments we have, the more optimistic people become and the more effort is invested in the area.
How can the industry cut the carbon footprint of respiratory care without compromising treatment?
This is a very important point. There is a strong focus on carbon emissions within healthcare. One of the key messages is that a green patient is a well-controlled patient. Poorly controlled disease leads to emergency visits and hospital admissions, which consume significant amounts of carbon.
There has been a lot of focus on pressurised metered dose inhalers, which have used propellants with global warming potential. New propellants are being developed with up to near zero global warming potential, which will address this issue.
There has also been some suggestion that we should switch everyone to dry powder inhalers, but that is not the right approach. What we need is choice so we can give the right drug in the right device to each patient. Different patients have different needs and preferences. A green inhaler for a patient is the one they can use effectively and that keeps them well controlled.
A green inhaler for a patient is the one they can use effectively and that keeps them well controlled
Looking ahead, what will define good respiratory care, particularly in terms of long-term outcomes?
It is about making an early and accurate diagnosis and delivering the right care to the right patient at the right time before damage has occurred. That means before loss of lung function, before repeated exacerbations and before significant exposure to oral corticosteroids and their side effects. If we can do that, we will transform outcomes for patients and also have a positive impact on healthcare systems, productivity and quality of life.
If you could change one thing about how healthcare is delivered today, what would it be and why?
I would focus on improving diagnosis. Respiratory diseases are difficult to diagnose, especially at scale. For example, in China, 70% of people with COPD have not been diagnosed. We need better ways to support diagnosis, particularly in primary care where most patients are managed. That could include new tools or the use of AI. If we get the diagnosis right at the beginning, it helps later down the line when we intervene with an effective therapy.
