Imperial College, London.
Eur Respir J. 2014 Feb;43(2):343-73. doi: 10.1183/09031936.00202013. Epub 2013 Dec 12.
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.
严重或治疗抵抗性哮喘日益被认为是一个重大的未满足的需求。一个由欧洲呼吸学会和美国胸科学会支持的工作组审查了定义，并就儿童和成人严重哮喘的评估和治疗提供了建议和指南。进行了文献回顾，然后根据 GRADE（推荐分级、评估、发展和评估）方法由专家委员会进行讨论，以制定具体的临床建议。当哮喘的诊断得到确认并解决了合并症后，严重哮喘被定义为需要高剂量吸入皮质类固醇加第二种控制器和/或全身皮质类固醇治疗以防止其变得“不受控制”或尽管进行了这种治疗仍保持“不受控制”的哮喘。严重哮喘是一种由表型组成的异质性疾病，如嗜酸性粒细胞性哮喘。提供了关于使用痰嗜酸性粒细胞计数和呼气一氧化氮指导治疗的具体建议，以及使用抗 IgE 抗体、甲氨蝶呤、大环内酯类抗生素、抗真菌药物和支气管热成形术的治疗建议。为改善表型而进行的协调研究将为严重哮喘治疗提供安全有效的基于生物标志物的方法。
