Abstract
Severe or therapy-resistant asthma is increasingly recognised as a major unmet need.
Supported by the American Thoracic Society (ATS) and European Respiratory Society (ERS), a Task Force reviewed the definition and provided recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults.
We performed a literature review followed by discussion by an expert committee according to the GRADE approach to develop 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.
- ERS
