Asthma diagnosis and treatmentSevere asthma in adults: What are the important questions?
Section snippets
Definition of severe asthma
The term severe refractory asthma applies to patients who remain difficult to control despite an extensive reevaluation of diagnosis, management, and an observational period of at least 6 months by an asthma specialist (Table I).
Most patients with asthma have mild-to-moderate disease that can be well controlled with standard treatment, including the regular use of inhaled corticosteroids (ICSs) combined with short-acting inhaled β2-agonists (SABAs) or long-acting inhaled β2-agonists (LABAs).
Epidemiology
Severe asthma is associated with an increased risk of hospitalization and death. Severe asthma in children but not in adults is associated with increased IgE. Female gender, obesity, and smoking are associated with more severe asthma and a poor response to therapy.
Few studies have attempted to quantify the prevalence of severe asthma, in large part because of variation between clinical and epidemiological definitions.30 However, it is estimated that 5% to 10% of the population with asthma has
Management of severe asthma
ICSs and bronchodilators are the mainstay of treatment for severe persistent asthma.
Although corticosteroids are extremely powerful anti-inflammatory medications, they are relatively less effective in the treatment of severe persistent asthma. In severe asthma, high doses are frequently prescribed without pharmacologic evidence for their utility but with increasing side effects. Few studies have examined doses >2000 μg day. In a study published by Reddel et al,99 a starting dose of 3200 μg/day
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Cited by (0)
Supported by an unrestricted grant from Novartis France and Centocor USA.
Disclosure of potential conflict of interest: P. Chanez has consulting arrangements with GlaxoSmithKline, AstraZeneca, Novartis, Aimirall, Centocor, Wyeth, Altana, and UCB and has received grant support from GlaxoSmithKline, Centocor, and Novartis. S. E. Wenzel has consulting arrangements with Genentech, Critical Therapeutics, and Centacor and is on the speakers' bureau for Critical Therapeutics and Genentech. L.-P. Boulet has consulting arrangements with Altana, AstraZeneca, GlaxoSmithKline, Novartis, and Merck Frost; has received grant support from 3M, Altana, Asthmatx, AstraZeneca, Boehringer-Ingelheim, Dynavas, Genentech, GlaxoSmithKline, IVAX, Merck Frost, Novartis, Pfizer, Roche, Schering, and Topigen; and is on the speakers' bureau for 3M, Altana, Asthmatx, AstraZeneca, Boehringer-Ingelheim, Dynavax, Genentech, GlaxoSmithKline, IVAX, Merck Frost, Novartis, Pfizer, Roche, Schering, and Topigen. C. E. Brightling has consulting arrangements with AstraZeneca and Cambridge Antibody Technology; has received grant support from AstraZeneca and Cambridge Antibody Technology; and is on the speakers' bureau for AstraZeneca, GlaxoSmithKline, Boehringer-Ingelheim, and NycoMed/Altana. W. W. Busse has consulting arrangements with Genentech/Novartis, Isis, GlaxoSmithKline, Altana, Wyeth, Pfizer, Dynavax, Novartis, Merck, and AstraZeneca. M. Castro has consulting arrangements with Asthmatx and Centocor and is on the speakers' bureau for Boehringer-Ingelheim, Critical Therapeutics, Genentech, and Pfizer. S. E. Dahien has consulting arrangements with Centocore, L. M. Fabbri Altana, AstraZeneca, Boehringer-Ingelheim, Chiesi, Farmaceutici, GlaxoSmithKline, Merck Sharp and Dohme, Novartis, Roche, and Pfizer and has received grant support from Altana, AstraZeneca, Boehringer-Ingelheim, Menarini, Miat, Schering-Plough, Chiesi, Farmaceutici, GlaxoSmithKline, Merck Sharp and Dohme, UCB, Pfizer, the Italian Ministry of Health, and the Italian Ministry for University and Research. S .T. Holgate has consulting arrangements with MSD, Novartis, Almirall Prosdesfarma, Synairgen, Rotta Pharmaceutical, Amgen, and CAT; owns stock in Synairgen; and has consulting arrangements with Novartis, Altana, AstraZeneca, GlaxoSmithKline, Pfizer, Schering-Plough, European Union GlaxoSmithKline, AstraZeneca, Novartis, Boehringer-Ingelheim, and Sanofi-Aventis. G. F. Joos has consulting arrangements with Centocore; has received grant support from Centocore; and is on the speakers' bureau for Novartis. B. Levy has consulting arrangements with Critical Therapeutics. K. F. Rabe has consulting arrangements with AstraZeneca, Boehringer-Ingelheim, Chiesi Pharmaceutical, Pfizer, Novartis, AltanaPharma, MSD, and GlaxoSmithKline; has received grant support from AltanaPharma, Novartis, Bayer, AstraZeneca, Pfizer, MSD, Exhale Therapeutics, Boehringer-Ingelheim, Roche, and GlaxoSmithKline; and is on the speakers' bureau for AstraZeneca, Boehringer-Ingelheim, Chiesi Pharmaceutical, Pfizer, Novartis, AltanaPharma, MSD, and GlaxoSmithKline. G. P. Anderson has consulting arrangements with AstraZeneca and is on the speakers' bureau for GlaxoSmithKline and AstraZeneca. The rest of the authors have declared that they have no conflict of interest.