To the Editor:
In their recent paper on severe asthma, Chung et al. [1] proposed excellent guidelines concerning this difficult topic. We commend them for having used the Grading of Recommendations Assessment, Development and Evaluation approach to study the evidence for the management of the disease. This method has been recognised to be of great importance for guideline development.
The authors have reviewed recent statements on severe asthma [2, 3] and agree upon most of the proposals discussed. However, these statements differ from those in the paper presented to the World Health Organisation [3]: they did not consider untreated asthma, probably because it is thought that this is a problem only for developing countries. We do not agree with this proposal; all patients in the world should have access to treatment to reduce exacerbations and deaths, and recommendations should be made for all patients. Moreover, this statement does not accord with the recent findings in developed countries. These findings have recently been widely publicised in the National Review of Asthma Deaths (NRAD) in the UK, run by a consortium of asthma professionals and patients, and led by the Royal College of Physicians [4]. This review looked into the circumstances surrounding deaths from asthma between 2012 and 2013. The NRAD was commissioned by National Health Service (NHS) England, NHS Wales, the Health and Social Care division of the Scottish government, the Department of Health, and the Northern Ireland Department of Health, Social Services and Public Safety. It was found that most asthma deaths were related to under-treatment or to a lack of controller treatment. We strongly think that untreated asthma must be considered a potential form of severe asthma, as people with asthma may experience severe asthma symptoms. We think that there should not be an over-reliance on mild asthma in untreated patients with a diagnosis of asthma.
In the recent document on airways integrated care pathways of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing [5], severe asthma is proposed to be considered in untreated patients. We think that patients with under-treatment should be added to this category, as they were found to be the highest risk group for asthma death [4].
Footnotes
Conflict of interest: Disclosures can be found alongside the online version of this article at erj.ersjournals.com
- Received June 4, 2014.
- Accepted June 12, 2014.
- ©ERS 2014