oa Current Allergy & Clinical Immunology - Severe asthma - assessment and management : review article

Volume 25, Issue 3
  • ISSN : 1609-3607



Around 5% of asthmatics have severe or difficult-to-control asthma, but they utilise a disproportionate amount of healthcare resources. Asthma that is not responding to treatment may be classified as 'problematic severe asthma', which is subcategorised into 'difficult-to-treat asthma' and 'severe therapy-resistant asthma'. The former group includes co-morbid conditions, adherence and/or technique problems, environmental allergens or irritants, and psychosocial problems, which all have to be assessed and managed before invasive investigations are undertaken to exclude other diagnoses and before stepping up treatment. A staged approach to assessment and management of problematic severe asthma is suggested. Options for therapy include high-dose inhaled corticosteroids (ICS), combinations of ICS and other controller medications, and novel therapies such as anti-IgE monoclonal antibody. New advances involve phenotyping severe asthma and individualising treatment according to the phenotype.

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