When the diagnosis of asthma is confirmed and comorbidities addressed, 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.
Severe asthma is a heterogeneous condition consisting of phenotypes such as eosinophilic asthma.
Specific recommendations are related to:
- use of sputum eosinophil count and exhaled nitric oxide to guide therapy,
- treatment with anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty
Severe asthma - differential diagnosis and management (click to enlarge the image):
Improved phenotyping may provide a biomarker-driven approach to severe asthma therapy.
References:
International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. ERJ February 1, 2014 vol. 43 no. 2 343-373
http://erj.ersjournals.com/content/43/2/343.abstract
Untangling asthma phenotypes and endotypes - 2012 Allergy free full text: http://goo.gl/DUzKU
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