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...
Table 1. Definition of Severe Asthma...
Table 2. Definition of High Daily Dose of Vari...
...is Context Recommendat...
...Diagnosis...
...uted tomography of chestIn children and a...
...m eosinophil counts...
...severe asthma, the ATS and ERS suggest treat...
...with severe asthma, the ATS and ERS suggest...
...d nitric oxide (FeNO)The ATS and ERS...
...es Which Can Masquerade as Severe Asthma...
...bidities and Contributory Factors Rhinosinusitis...
Treatment
...Treat...
...Table 6. Recom...
...IgE antibody (omalizumab...
...nts with severe allergic asthma the ATS...
...children. (C, VL)620...
...thotrexateThe ATS and ERS suggest that clinicians...
...tibioticsThe ATS and ERS suggest that cli...
...ntifungal agents...
...and ERS suggest antifungal agents in adults...
...ATS and ERS suggest that clinicians do NOT use an...
...plastyThe ATS recommends that bron...
...able 7. Quick Relief Medications...
...aled Corticosteroids...
...able 9. Combined Long-Acting Beta Agonist Plus In...
...ble 10. Long-Term Control Medications G...