TY - JOUR
T1 - Management of severe asthma
T2 - A European Respiratory Society/American Thoracic Society guideline
AU - Holguin, Fernando
AU - Cardet, Juan Carlos
AU - Chung, Kian Fan
AU - Diver, Sarah
AU - Ferreira, Diogenes S.
AU - Fitzpatrick, Anne
AU - Gaga, Mina
AU - Kellermeyer, Liz
AU - Khurana, Sandhya
AU - Knight, Shandra
AU - McDonald, Vanessa M.
AU - Morgan, Rebecca L.
AU - Ortega, Victor E.
AU - Rigau, David
AU - Subbarao, Padmaja
AU - Tonia, Thomy
AU - Adcock, Ian M.
AU - Bleecker, Eugene R.
AU - Brightling, Chris
AU - Boulet, Louis Philippe
AU - Cabana, Michael
AU - Castro, Mario
AU - Chanez, Pascal
AU - Custovic, Adnan
AU - Djukanovic, Ratko
AU - Frey, Urs
AU - Frankemölle, Betty
AU - Gibson, Peter
AU - Hamerlijnck, Dominique
AU - Jarjour, Nizar
AU - Konno, Satoshi
AU - Shen, Huahao
AU - Vitary, Cathy
AU - Bush, Andy
N1 - Publisher Copyright:
Copyright © ERS 2020
PY - 2020/1/1
Y1 - 2020/1/1
N2 - This document provides clinical recommendations for the management of severe asthma. Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the European Respiratory Society/American Thoracic Society Task Force's questions. The evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of asthma experts, who made specific recommendations on six specific questions. After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made the following recommendations: 1) suggest using anti-interleukin (IL)-5 and anti-IL-5 receptor α for severe uncontrolled adult eosinophilic asthma phenotypes; 2) suggest using a blood eosinophil cut-point ≥150 μL−1 to guide anti-IL-5 initiation in adult patients with severe asthma; 3) suggest considering specific eosinophil (≥260 μL−1) and exhaled nitric oxide fraction (≥19.5 ppb) cut-offs to identify adolescents or adults with the greatest likelihood of response to anti-IgE therapy; 4) suggest using inhaled tiotropium for adolescents and adults with severe uncontrolled asthma despite Global Initiative for Asthma (GINA) step 4-5 or National Asthma Education and Prevention Program (NAEPP) step 5 therapies; 5) suggest a trial of chronic macrolide therapy to reduce asthma exacerbations in persistently symptomatic or uncontrolled patients on GINA step 5 or NAEPP step 5 therapies, irrespective of asthma phenotype; and 6) suggest using anti-IL-4/13 for adult patients with severe eosinophilic asthma and for those with severe corticosteroid-dependent asthma regardless of blood eosinophil levels. These recommendations should be reconsidered as new evidence becomes available.
AB - This document provides clinical recommendations for the management of severe asthma. Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the European Respiratory Society/American Thoracic Society Task Force's questions. The evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of asthma experts, who made specific recommendations on six specific questions. After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made the following recommendations: 1) suggest using anti-interleukin (IL)-5 and anti-IL-5 receptor α for severe uncontrolled adult eosinophilic asthma phenotypes; 2) suggest using a blood eosinophil cut-point ≥150 μL−1 to guide anti-IL-5 initiation in adult patients with severe asthma; 3) suggest considering specific eosinophil (≥260 μL−1) and exhaled nitric oxide fraction (≥19.5 ppb) cut-offs to identify adolescents or adults with the greatest likelihood of response to anti-IgE therapy; 4) suggest using inhaled tiotropium for adolescents and adults with severe uncontrolled asthma despite Global Initiative for Asthma (GINA) step 4-5 or National Asthma Education and Prevention Program (NAEPP) step 5 therapies; 5) suggest a trial of chronic macrolide therapy to reduce asthma exacerbations in persistently symptomatic or uncontrolled patients on GINA step 5 or NAEPP step 5 therapies, irrespective of asthma phenotype; and 6) suggest using anti-IL-4/13 for adult patients with severe eosinophilic asthma and for those with severe corticosteroid-dependent asthma regardless of blood eosinophil levels. These recommendations should be reconsidered as new evidence becomes available.
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U2 - 10.1183/13993003.00588-2019
DO - 10.1183/13993003.00588-2019
M3 - Article
C2 - 31558662
AN - SCOPUS:85077155298
SN - 0903-1936
VL - 55
JO - European Respiratory Journal
JF - European Respiratory Journal
IS - 1
M1 - 1900588
ER -