Definition, Evaluation and Treatment of Severe Asthma
Key Points
Key Points
- Severe asthma is defined as asthma that requires treatment with high dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming ‘‘uncontrolled’’ or that remains ‘‘uncontrolled’’ despite this therapy. (See Tables 1 & 2)
- Severe asthma is a heterogeneous condition consisting of phenotypes such as severe allergic asthma, eosinophilic asthma, neutrophilic asthma, chronic airflow obstruction, recurrent exacerbations and corticosteroid insensitivity.
- The prevalence of severe asthma in adults and children is estimated to be 5–10% of the total asthma population.
- The ATS/ERS Severe Asthma guidelines make recommendations addressing the roles of computed tomography, sputum eosinophils, and exhaled nitric oxide in the diagnosis of severe asthma.
(see Table 3) - The ATS/ERS Severe Asthma guidelines make recommendations addressing the roles of anti-IgE antibody, methotrexate, macrolide antibiotics, anti-fungal agents, and bronchial thermoplasty in the treatment of severe asthma. (see Table 6)
Diagnosis
Diagno...
...able 1. Definition of Severe Asthma for Pat...
...e 2. Definition of High Daily Dose of V...
...DiagnosisHaving trouble viewing table? Expa...
Diagnosis (Tab...
...graphy of chestIn children and adults...
...putum eosinophil...
...ith severe asthma, the ATS and ERS s...
...en with severe asthma, the ATS and ERS sugge...
...led nitric oxide (FeNO)The ATS and...
...e 4. Diseases Which Can Masquerade as Severe A...
...Comorbidities and Contributory FactorsH...
Treatment
...atment
...e 6. Recommended Therapies...
...antibody (omalizumab)...
...atients with severe allergic asthm...
...dren. (C, VL)620...
...e ATS and ERS suggest that clinicians do NOT u...
...rolide antibioticsThe ATS and ERS suggest that cli...
...ifungal agen...
...and ERS suggest antifungal agents in adult...
...nd ERS suggest that clinicians do N...
...onchial ThermoplastyThe ATS recommends that b...
Table 7. Quick Relief MedicationsHaving trouble v...
...haled CorticosteroidsHaving trouble viewi...
...Combined Long-Acting Beta Agonist Plus Inhaled...
...Long-Term Control MedicationsHaving t...