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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Treatment

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