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International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

Kian Fan Chung, Sally E. Wenzel, Jan L. Brozek, Andrew Bush, Mario Castro, Peter J. Sterk, Ian M. Adcock, Eric D. Bateman, Elisabeth H. Bel, Eugene R. Bleecker, Louis-Philippe Boulet, Christopher Brightling, Pascal Chanez, Sven-Erik Dahlen, Ratko Djukanovic, Urs Frey, Mina Gaga, Peter Gibson, Qutayba Hamid, Nizar N. Jajour, Thais Mauad, Ronald L. Sorkness, W. Gerald Teague
European Respiratory Journal 2014 43: 343-373; DOI: 10.1183/09031936.00202013
Kian Fan Chung
National Heart and Lung Institute, Imperial College, LondonBiomedical Research Unit, Royal Brompton Hospital, LondonBoth authors contributed equally
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  • For correspondence: f.chung@imperial.ac.uk
Sally E. Wenzel
Dept of Medicine, University of Pittsburgh, Pittsburgh, PABoth authors contributed equally
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Jan L. Brozek
Dept of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario
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Andrew Bush
National Heart and Lung Institute, Imperial College, LondonBiomedical Research Unit, Royal Brompton Hospital, London
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Mario Castro
Dept of Medicine, Washington University, St Louis, MO
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Peter J. Sterk
Dept of Respiratory Medicine, Academic Medical Centre, Amsterdam, The Netherlands
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Ian M. Adcock
National Heart and Lung Institute, Imperial College, London
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Eric D. Bateman
Lung Institute, University of Cape Town, Cape Town, South Africa
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Elisabeth H. Bel
Dept of Respiratory Medicine, Academic Medical Centre, Amsterdam, The Netherlands
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Eugene R. Bleecker
Dept of Medicine, Wake Forest University, Winston Salem, NC
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Louis-Philippe Boulet
Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec, Quebec
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Christopher Brightling
Institute for Lung Health, Leicester University, Leicester
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Pascal Chanez
Departement des Maladies Respiratoires, Marseille Universite, Marseille, France
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Sven-Erik Dahlen
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Ratko Djukanovic
Southampton NIHR Respiratory Biomedical Research Unit, University of Southampton School of Medicine and Southampton General Hospital, Southampton UK
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Urs Frey
University Children’s Hospital (UKBB), University of Basel, Basel, Switzerland
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Mina Gaga
7th Respiratory Dept and Asthma Centre, Athens Chest Hospital, Athens, Greece
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Peter Gibson
Hunter Medical Research Institute, John Hunter Hospital, Newcastle, Australia
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Qutayba Hamid
Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada
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Nizar N. Jajour
Dept of Medicine, University of Wisconsin, Madison, WI
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Thais Mauad
Dept of Pathology, University Medical School, Sao Paulo, Brazil
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Ronald L. Sorkness
Dept of Medicine, University of Wisconsin, Madison, WI
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W. Gerald Teague
Division of Respiratory Medicine, Allergy, and Immunology, Dept of Paediatrics, University of Virginia School of Medicine, VA, USA
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This article has corrections. Please see:

  • “International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma.” Kian Fan Chung, Sally E. Wenzel, Jan L. Brozek, Andrew Bush, Mario Castro, Peter J. Sterk, Ian M. Adcock, Eric D. Bateman, Elisabeth H. Bel, Eugene R. Bleecker, Louis-Philippe Boulet, Christopher Brightling, Pascal Chanez, Sven-Erik Dahlen, Ratko Djukanovic, Urs Frey, Mina Gaga, Peter Gibson, Qutayba Hamid, Nizar N. Jajour, Thais Mauad, Ronald L. Sorkness and W. Gerald Teague. Eur Respir J 2014; 43: 343–373. - April 01, 2014
  • “International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma.” Kian Fan Chung, Sally E. Wenzel, Jan L. Brozek, Andrew Bush, Mario Castro, Peter J. Sterk, Ian M. Adcock, Eric D. Bateman, Elisabeth H. Bel, Eugene R. Bleecker, Louis-Philippe Boulet, Christopher Brightling, Pascal Chanez, Sven-Erik Dahlen, Ratko Djukanovic, Urs Frey, Mina Gaga, Peter Gibson, Qutayba Hamid, Nizar N. Jajour, Thais Mauad, Ronald L. Sorkness and W. Gerald Teague. Eur Respir J 2014; 43: 343–373. - July 01, 2018

Abstract

Severe or therapy-resistant asthma is increasingly recognised as a major unmet need. A Task Force, supported by the European Respiratory Society and American Thoracic Society, reviewed the definition and provided recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults.

A literature review was performed, followed by discussion by an expert committee according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach for development of specific clinical recommendations.

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 on the use of sputum eosinophil count and exhaled nitric oxide to guide therapy, as well as treatment with anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty are provided.

Coordinated research efforts for improved phenotyping will provide safe and effective biomarker-driven approaches to severe asthma therapy.

Abstract

ERS/ATS guidelines revise the definition of severe asthma, discuss phenotypes and provide guidance on patient management http://ow.ly/roufI

Footnotes

  • As a result of the corrections published in the April 2014 and July 2018 issues of the European Respiratory Journal, the online version of this article has been revised.

  • For editorial comments see page 315.

  • A press release for this article is available from www.erj.ersjournals.com/site/misc/presspack.xhtml

  • This article has supplementary material available from www.erj.ersjournals.com

  • Conflict of interest: Disclosures can be found alongside the online version of this article at www.erj.ersjournals.com

  • Received November 19, 2013.
  • Accepted November 26, 2013.
  • ©ERS 2014
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European Respiratory Journal: 43 (2)
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International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma
Kian Fan Chung, Sally E. Wenzel, Jan L. Brozek, Andrew Bush, Mario Castro, Peter J. Sterk, Ian M. Adcock, Eric D. Bateman, Elisabeth H. Bel, Eugene R. Bleecker, Louis-Philippe Boulet, Christopher Brightling, Pascal Chanez, Sven-Erik Dahlen, Ratko Djukanovic, Urs Frey, Mina Gaga, Peter Gibson, Qutayba Hamid, Nizar N. Jajour, Thais Mauad, Ronald L. Sorkness, W. Gerald Teague
European Respiratory Journal Feb 2014, 43 (2) 343-373; DOI: 10.1183/09031936.00202013

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International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma
Kian Fan Chung, Sally E. Wenzel, Jan L. Brozek, Andrew Bush, Mario Castro, Peter J. Sterk, Ian M. Adcock, Eric D. Bateman, Elisabeth H. Bel, Eugene R. Bleecker, Louis-Philippe Boulet, Christopher Brightling, Pascal Chanez, Sven-Erik Dahlen, Ratko Djukanovic, Urs Frey, Mina Gaga, Peter Gibson, Qutayba Hamid, Nizar N. Jajour, Thais Mauad, Ronald L. Sorkness, W. Gerald Teague
European Respiratory Journal Feb 2014, 43 (2) 343-373; DOI: 10.1183/09031936.00202013
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  • Article
    • Abstract
    • Abstract
    • Executive Summary
    • Recommendations
    • Scope and purpose
    • Introduction
    • Methods
    • How to use these guidelines
    • 1. Task Force definition of severe asthma
    • 2. Phenotyping: epidemiology, pathogenesis, pathobiology, structure and physiology
    • 3. Evaluation
    • 4. Therapy
    • Conclusion
    • Footnotes
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  • ERS/ATS guidelines: NIV for acute respiratory failure
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