Allergology Clinical Management Unit, Virgen Macarena Hospital, Seville, Spain; SEAIC Asthma Committee.
Allergy Service, University Hospital, Salamanca; Associate Professor, Department of Biomedical and Diagnostics Science, School of Medicine, Salamanca; SEAIC Asthma Committee.
J Investig Allergol Clin Immunol. 2021 Feb 17;31(1):36-43. doi: 10.18176/jiaci.0638. Epub 2020 Aug 26.
The definition of severe uncontrolled asthma and the best phenotype-driven management are not fully established. Objective: We aimed to reach a consensus on the definition of severe uncontrolled asthma and give recommendations on optimal management with phenotype-targeted biological therapies.
A modified Delphi technique was used. A scientific committee provided statements addressing the definition of severe uncontrolled asthma and controversial issues about its treatment with biologics. The questionnaire was evaluated in 2 rounds by expert allergists. With the results, the scientific committee developed recommendations and a practical algorithm.
A panel of 27 allergists reached agreement on 27 out of the 29 items provided (93.1%). A consensus definition of severe uncontrolled asthma was agreed. Prior to initiation of therapy, it is mandatory to establish the asthma phenotype and assess the presence of clinically important allergic sensitizations. Anti-IgE, anti-IL-5, anti-IL-5 receptor, and anti-IL-13/IL-4 receptor inhibitors are suitable options for patients with allergic asthma and a blood eosinophil level >300/μL (>150/μL in patients receiving oral corticosteroids). IL-5 and anti-IL-5 receptor inhibitors are recommended for patients with an eosinophilic phenotype and can also be used for patients with severe eosinophilic allergic asthma with no or a suboptimal response to omalizumab. Dupilumab is recommended for patients with moderate-severe asthma and a TH2-high phenotype. Only physicians with experience in the treatment of severe uncontrolled asthma should initiate biological treatment.
We provide consensus clinical recommendations that may be useful in the management of patients with severe uncontrolled asthma.
严重未控制哮喘的定义以及最佳表型驱动管理尚未完全确定。目的：我们旨在就严重未控制哮喘的定义达成共识，并就表型靶向生物疗法的最佳管理提供建议。
采用改良 Delphi 技术。一个科学委员会提供了关于严重未控制哮喘的定义以及生物制剂治疗相关争议问题的陈述。该问卷在两轮由过敏专家进行评估。根据结果，科学委员会制定了建议和实用算法。
27 名过敏专家组成的小组就提供的 29 项中的 27 项（93.1%）达成一致。达成了严重未控制哮喘的共识定义。在开始治疗之前，必须确定哮喘表型并评估是否存在具有临床重要意义的过敏致敏。抗 IgE、抗 IL-5、抗 IL-5 受体和抗 IL-13/IL-4 受体抑制剂适用于过敏哮喘患者和血嗜酸粒细胞水平>300/μL（正在接受口服皮质类固醇治疗的患者>150/μL）。IL-5 和抗 IL-5 受体抑制剂推荐用于嗜酸粒细胞表型患者，也可用于严重嗜酸粒细胞性过敏哮喘患者，这些患者对奥马珠单抗无反应或反应不佳。度普利尤单抗推荐用于 TH2 高表型的中重度哮喘患者。只有具有严重未控制哮喘治疗经验的医生才能启动生物治疗。
我们提供了可能有助于严重未控制哮喘患者管理的共识临床建议。
