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
Diagnosis
...e 1. Definition of Severe Asthma for Patients Aged...
...2. Definition of High Daily Dose of Vari...
...3. DiagnosisHaving trouble viewing t...
...nosis (Table 3)...
...mography of chestIn children and a...
...osinophil counts
...h severe asthma, the ATS and ERS s...
...ldren with severe asthma, the ATS and ER...
...d nitric oxide (FeNO)The ATS and ERS suggest t...
...e 4. Diseases Which Can Masquerade as Sev...
.... Comorbidities and Contributory FactorsHav...
Treatment
...atment...
...Recommended Therapies...
...antibody (omalizumab)...
...with severe allergic asthma the ATS a...
...dren. (C, VL)620...
...The ATS and ERS suggest that clinicians do NOT use...
...antibioticsThe ATS and ERS suggest that...
...ungal agents...
...ERS suggest antifungal agents in adults with sever...
...suggest that clinicians do NOT use antifungal ag...
...rmoplastyThe ATS recommends that bronchial thermop...
...uick Relief MedicationsHaving trouble...
Table 8. Inhaled CorticosteroidsHaving...
...ble 9. Combined Long-Acting Beta Agonist Plus Inh...
...le 10. Long-Term Control MedicationsHaving troubl...