Diagnosis and definition of severe refractory asthma: an international consensus statement from the Innovative Medicine Initiative (IMI)

Bel, Elisabeth H.; Sousa, Ana R.; Fleming, Louise; Bush, Andy; Chung, Kian Fan; Versnel, Jenny; Wagener, Ariane H.; Wagers, Scott; Sterk, Peter J.; Compton, Chris

doi:10.1136/thx.2010.153643

Cited by 308 publications

(298 citation statements)

References 86 publications

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“…In patients .6 years of age, ''Gold Standard/International Guidelines treatment'' is high dose ICS plus a longacting b 2 -agonist (LABA), leukotriene modifier or theophylline and/or continuous or near continuous systemic corticosteroids as background therapy [4][5][6][7]. This definition is similar to the recent Innovative Medicine Initiative [8], but does not address the group of patients identified by the World Health Organization with untreated severe asthma [9]. Although untreated severe asthma is an enormous problem in many areas where current therapies are not widely available, the definition of severe asthma agreed upon by the 2013 ATS/ERS Task Force focuses on severe asthma refractory or insensitive to currently available medications, including corticosteroids, and asthma complicated by comorbidities, the types of greatest concern to the countries primarily served by the two societies [9].…”

Section: Task Force Definition Of Severe Asthmamentioning

confidence: 99%

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

et al. 2013

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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.

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Section: Task Force Definition Of Severe Asthmamentioning

confidence: 99%

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

et al. 2013

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“…The assessment of difficult asthma should be done by using a systematic approach [1,4,8] in a specialist center, as this leads to better treatment outcomes and saves costs [2,154,155]. Systematic assessment is also important in ensuring that novel expensive treatments are only used in patients likely to respond.…”

Section: Management Of Severe Asthmamentioning

confidence: 99%

“…There are a number of potential causes of poor symptom control in asthma [4], and systematic assessment is important when differentiating between patients with severe asthma, and patients with other causes of poor asthma control, such as lack of adherence or co-morbidities, termed ‘difficult-to-treat’ asthma.…”

Section: Introductionmentioning

confidence: 99%

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

Porsbjerg

Ulrik

Skjold

et al. 2018

European Clinical Respiratory Journal

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Although a minority of asthma patients suffer from severe asthma, they represent a major clinical challenge in terms of poor symptom control despite high-dose treatment, risk of exacerbations, and side effects. Novel biological treatments may benefit patients with severe asthma, but are expensive, and are only effective in appropriately targeted patients. In some patients, symptoms are driven by other factors than asthma, and all patients with suspected severe asthma (‘difficult asthma’) should undergo systematic assessment, in order to differentiate between true severe asthma, and ‘difficult-to-treat’ patients, in whom poor control is related to factors such as poor adherence or co-morbidities. The Nordic Consensus Statement on severe asthma was developed by the Nordic Severe Asthma Network, consisting of members from Norway, Sweden, Finland, Denmark, Iceland and Estonia, including representatives from the respective national respiratory scientific societies with the aim to provide an overview and recommendations regarding the diagnosis, systematic assessment and management of severe asthma. Furthermore, the Consensus Statement proposes recommendations for the organization of severe asthma management in primary, secondary, and tertiary care.

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“…Assessment of specific phenotypic characteristics Asthma severity Asthma severity was assessed according to the Innovative Medicines Initiative criteria [21], based on medication use and degree of asthma control. Severe asthma was defined by the use of ⩾1000 µg·day −1 fluticasone equivalent and/or daily oral corticosteroids plus a second controller, combined with an asthma control score >1.5 [22] on the JUNIPER et al [23] asthma control questionnaire or at least two exacerbations in the past 12 months.…”

Section: Patientsmentioning

confidence: 99%

Biomarkers to identify sputum eosinophilia in different adult asthma phenotypes

et al. 2015

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Several biomarkers have been used to assess sputum eosinophilia in asthma. It has been suggested that the diagnostic accuracy of these biomarkers might differ between asthma phenotypes. We investigated the accuracy of biomarkers in detecting sputum eosinophilia (⩾3%) in different adult asthma phenotypes.Levels of eosinophils in blood and sputum, exhaled nitric oxide fraction (FeNO) and total immunoglobulin (Ig)E from 336 adult patients, enrolled in three prospective observational clinical trials and recruited at five pulmonology outpatient departments, were analysed. Areas under the receiver operating characteristics curves (AUC) for detecting sputum eosinophilia were calculated and compared between severe and mild, obese and nonobese, atopic and nonatopic and (ex-)smoking and never-smoking asthma patients.Sputum eosinophilia was present in 116 patients (35%). In the total group the AUC was 0.83 (95% CI 0.78-0.87) for blood eosinophils, 0.82 (0.77-0.87) for FeNO and 0.69 (0.63-0.75) for total IgE. AUCs were similar for blood eosinophils and FeNO between different phenotypes. Total IgE was less accurate in detecting sputum eosinophilia in atopic and obese patients than in nonatopic and nonobese patients.Blood eosinophils and FeNO had comparable diagnostic accuracy (superior to total IgE) in identifying sputum eosinophilia in adult asthma patients, irrespective of asthma phenotype such as severe, nonatopic, obese and smoking-related asthma. @ERSpublications FeNO and blood eosinophils can be used to detect sputum eosinophilia in adult asthma patients regardless of phenotype

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Diagnosis and definition of severe refractory asthma: an international consensus statement from the Innovative Medicine Initiative (IMI)

Cited by 308 publications

References 86 publications

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

Biomarkers to identify sputum eosinophilia in different adult asthma phenotypes

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