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Recommendation for optimal management of severe refractory asthma

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Authors: Jaymin B Morjaria, Riccardo Polosa

Published Date July 2010 , Volume 2010:3 Pages 43 - 56 DOI 10.2147/JAA.S6710

Jaymin B Morjaria1, Riccardo Polosa2

1Department of IIR, University of Southampton, Southampton, UK; 2Dipartimento di Medicina Interna e Specialistica, University of Catania, Catania, Italy

Abstract: Patients whose asthma is not adequately controlled despite treatment with a ­combination of high dose inhaled corticosteroids and long-acting bronchodilators pose a major clinical challenge and an important health care problem. Patients with severe refractory disease often require regular oral corticosteroid use with an increased risk of steroid-related adverse events. Alternatively, immunomodulatory and biologic therapies may be considered, but they show wide variation in efficacy across studies thus limiting their generalizability. Managing asthma that is refractory to standard treatment requires a systematic approach to evaluate ­adherence, ensure a correct diagnosis, and identify coexisting disorders and trigger factors. In future, ­phenotyping of patients with severe refractory asthma will also become an ­important element of this systematic approach, because it could be of help in guiding and tailoring ­treatments. Here, we propose a pragmatic management approach in diagnosing and treating this challenging subset of asthmatic patients.

Keywords: severe asthma, corticosteroids, immunological modifiers, steroid-sparing, ­anti-TNF-a drugs, omalizumab, mepolizumab, daclizumab, bronchial thermoplasty
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