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- Chung, KF, et al.
(författare)
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International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma
- 2014
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Ingår i: The European respiratory journal. - : European Respiratory Society (ERS). - 1399-3003 .- 0903-1936. ; 43:2, s. 343-373
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Tidskriftsartikel (refereegranskat)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.
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- Custovic, A., et al.
(författare)
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EAACI position statement on asthma exacerbations and severe asthma
- 2013
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Ingår i: Allergy. - : Wiley. - 0105-4538. ; 68:12, s. 1520-1531
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Tidskriftsartikel (refereegranskat)abstract
- Asthma exacerbations and severe asthma are linked with high morbidity, significant mortality and high treatment costs. Recurrent asthma exacerbations cause a decline in lung function and, in childhood, are linked to development of persistent asthma. This position paper, from the European Academy of Allergy and Clinical Immunology, highlights the shortcomings of current treatment guidelines for patients suffering from frequent asthma exacerbations and those with difficult-to-treat asthma and severe treatment-resistant asthma. It reviews current evidence that supports a call for increased awareness of (i) the seriousness of asthma exacerbations and (ii) the need for novel treatment strategies in specific forms of severe treatment-resistant asthma. There is strong evidence linking asthma exacerbations with viral airway infection and underlying deficiencies in innate immunity and evidence of a synergism between viral infection and allergic mechanisms in increasing risk of exacerbations. Nonadherence to prescribed medication has been identified as a common clinical problem amongst adults and children with difficult-to-control asthma. Appropriate diagnosis, assessment of adherence and other potentially modifiable factors (such as passive or active smoking, ongoing allergen exposure, psychosocial factors) have to be a priority in clinical assessment of all patients with difficult-to-control asthma. Further studies with improved designs and new diagnostic tools are needed to properly characterize (i) the pathophysiology and risk of asthma exacerbations, and (ii) the clinical and pathophysiological heterogeneity of severe asthma.
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- Samitas, Konstantinos, 1977, et al.
(författare)
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Osteopontin expression and relation to disease severity in human asthma.
- 2011
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Ingår i: The European respiratory journal. - : European Respiratory Society (ERS). - 1399-3003 .- 0903-1936. ; 37:2, s. 331-341
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Tidskriftsartikel (refereegranskat)abstract
- Recent studies have associated osteopontin (Opn) with allergic inflammation; however, its role in human asthma remains unclear. We measured Opn levels in serum, bronchoalveolar lavage fluid (BALF) and bronchial tissue of healthy controls and asthmatics, identified cellular sources of Opn and examined possible correlations between Opn expression, disease severity and airway remodeling. Serum samples were obtained from 35 mild-moderate (MMA), 19 severe asthmatics (SA) and 17 healthy controls in steady state and in case of exacerbation. Of these subjects, 29 asthmatics and 9 controls underwent bronchoscopy with endobronchial biopsy and BALF collection. Opn expression was determined by ELISA and immunohistochemistry/immunofluorescence. Reticular basement membrane (RBM) thickness and goblet cell hyperplasia were also determined. Serum and BALF Opn levels were significantly increased in all asthmatics in steady state, while serum levels decreased during exacerbations. Opn was upregulated in the bronchial tissue of all patients and expressed by epithelial, airway and vascular smooth muscle cells, myofibroblasts, T-lymphocytes and mast cells. Opn expression correlated with RBM thickness and was more prominent in subepithelial inflammatory cells in severe compared to mild-moderate asthma. Opn expression is upregulated in human asthma, is associated with remodeling changes and its subepithelial expression correlates to disease severity.
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