TY - JOUR T1 - Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.00588-2019 VL - 55 IS - 1 SP - 1900588 AU - Fernando Holguin AU - Juan Carlos Cardet AU - Kian Fan Chung AU - Sarah Diver AU - Diogenes S. Ferreira AU - Anne Fitzpatrick AU - Mina Gaga AU - Liz Kellermeyer AU - Sandhya Khurana AU - Shandra Knight AU - Vanessa M. McDonald AU - Rebecca L. Morgan AU - Victor E. Ortega AU - David Rigau AU - Padmaja Subbarao AU - Thomy Tonia AU - Ian M. Adcock AU - Eugene R. Bleecker AU - Chris Brightling AU - Louis-Philippe Boulet AU - Michael Cabana AU - Mario Castro AU - Pascal Chanez AU - Adnan Custovic AU - Ratko Djukanovic AU - Urs Frey AU - Betty Frankemölle AU - Peter Gibson AU - Dominique Hamerlijnck AU - Nizar Jarjour AU - Satoshi Konno AU - Huahao Shen AU - Cathy Vitary AU - Andy Bush Y1 - 2020/01/01 UR - http://erj.ersjournals.com/content/55/1/1900588.abstract N2 - This document provides clinical recommendations for the management of severe asthma. Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the European Respiratory Society/American Thoracic Society Task Force's questions. The evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of asthma experts, who made specific recommendations on six specific questions. After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made the following recommendations: 1) suggest using anti-interleukin (IL)-5 and anti-IL-5 receptor α for severe uncontrolled adult eosinophilic asthma phenotypes; 2) suggest using a blood eosinophil cut-point ≥150 μL−1 to guide anti-IL-5 initiation in adult patients with severe asthma; 3) suggest considering specific eosinophil (≥260 μL−1) and exhaled nitric oxide fraction (≥19.5 ppb) cut-offs to identify adolescents or adults with the greatest likelihood of response to anti-IgE therapy; 4) suggest using inhaled tiotropium for adolescents and adults with severe uncontrolled asthma despite Global Initiative for Asthma (GINA) step 4–5 or National Asthma Education and Prevention Program (NAEPP) step 5 therapies; 5) suggest a trial of chronic macrolide therapy to reduce asthma exacerbations in persistently symptomatic or uncontrolled patients on GINA step 5 or NAEPP step 5 therapies, irrespective of asthma phenotype; and 6) suggest using anti-IL-4/13 for adult patients with severe eosinophilic asthma and for those with severe corticosteroid-dependent asthma regardless of blood eosinophil levels. These recommendations should be reconsidered as new evidence becomes available.The ERS/ATS Task Force makes recommendations on the use of novel therapies for severe asthma, specifically biologicals for type 2 high asthma, and antimuscarinic agents and macrolides, as well as on biomarkers for predicting treatment response http://bit.ly/2kZLRaD ER -