Definition, Evaluation and Treatment of Severe Asthma

Publication Date: February 3, 2014

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

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...1. Definition of Severe Asthma for Patients Age...


...ble 2. Definition of High Daily Dose...


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Diagnosis (Table 3)

...ted tomography of chestIn children and adults w...

...utum eosinophil cou...

...h severe asthma, the ATS and ERS suggest treatment...

...h severe asthma, the ATS and ERS suggest treatment...

...ed nitric oxide (FeNO)The ATS and ERS s...

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Treatment

Treatm...

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...patients with severe allergic asthma the ATS and E...

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...antibioticsThe ATS and ERS suggest that clinici...

...ntifungal ag...

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The ATS and ERS suggest that clinici...

...chial ThermoplastyThe ATS recommends that bronc...


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...Long-Term Control MedicationsHaving...