Loading your page…
Loading your page…
Published by European Respiratory Society/American Thoracic Society · GRADE
The guideline provides clinical recommendations for the management of severe asthma, focusing on the use of novel biological therapies for type 2 high asthma, antimuscarinic agents, macrolides, and the use of biomarkers for predicting treatment response.
Key Takeaways
Unlike the 2014 first Task Force guidelines which considered general management strategies, this update focused specifically on six PICOs related to the rapid introduction of novel treatments (biologicals, antimuscarinic agents, and macrolides) and predictive biomarkers.
We suggest an anti-IL-5 strategy as add-on therapy for adult patients with severe uncontrolled asthma with an eosinophilic phenotype and for those with severe corticosteroid-dependent asthma
We suggest that a blood eosinophil cut-point >=150 µL−1 can be used to guide anti-IL-5 initiation in adult patients with severe asthma and a history of prior asthma exacerbations
We suggest using a blood eosinophil cut-off >=260 µL−1 to identify adolescents (>12 years) and adults with severe allergic asthma more likely to benefit from anti-IgE treatment
We suggest using a FENO cut-off >=19.5 ppb to identify adolescents (>12 years) and adults with severe allergic asthma more likely to benefit from anti-IgE treatment
For children, adolescents and adults with severe asthma uncontrolled despite GINA step 4–5 or NAEPP step 5 therapies, we recommend the addition of tiotropium
We suggest a trial of macrolide treatment to reduce asthma exacerbations in adult asthma subjects on GINA/NAEPP step 5 therapy that remain persistently symptomatic or uncontrolled
We suggest against the use of chronic macrolide treatment in children and adolescents with severe uncontrolled asthma
We suggest dupilumab as add-on therapy for adult patients with severe eosinophilic asthma and for those with severe corticosteroid-dependent asthma regardless of eosinophil levels
Clinical Topic
severe asthma
Objectives
This document provides clinical recommendations for the management of severe asthma.
Target Patient Population
adults and children (>5 years) with severe asthma
Diagnostic Criteria
Asthma that requires treatment with high dose inhaled corticosteroids plus a second controller (and/or systemic corticosteroids) to prevent it from becoming 'uncontrolled' or which remains 'uncontrolled' despite this therapy.
Target Providers
Therapeutic Area
RespiratoryGuideline Scope
Special Populations
System: GRADE
Recommendation Strength
Difficulty
advanced
Learning Paths