Updated Global Initiative for Asthma (GINA) guidelines on Asthma Management and Prevention.
Severe asthma imposes a significant burden on patients, families and healthcare systems.
Management is difficult, due to disease heterogeneity and comorbidities. Better understanding of the mechanisms has enabled a stratified approach to the management of severe asthma, supporting the use of targeted treatments with biologicals. This guidelines addresses issues such as selection of biologicals, as they target overlapping disease phenotypes, the definition of response, strategies to enhance the responder rate, the duration of treatment and its regimen (in the clinic or home-based) and its cost-effectiveness.
This document provides clinical recommendations for the management of severe asthma. The following recommendations are made: 1) using IL-5 and anti-IL5 receptor α for severe uncontrolled adult eosinophilic asthma phenotypes; 2) using a blood eosinophil cut-point ⩾150 μL−1 to guide anti-IL-5 initiation in adult patients with severe asthma; 3) 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) using inhaled tiotropium for adolescents and adults with severe uncontrolled asthma despite GINA step 4–5 therapies; 5) a trial of chronic macrolide therapy to reduce asthma exacerbations in persistently symptomatic or uncontrolled patients on GINA step 5 irrespective of asthma phenotype; 6) 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.
This guideline covers diagnosing, monitoring and managing asthma in adults, young people and children. It aims to improve the accuracy of diagnosis, help people to control their asthma and reduce the risk of asthma attacks. It does not cover managing severe asthma or acute asthma attacks.
This guide provides a practical summary on how to assess and manage Difficult to treat and Severe Asthma in adults and adolescents.
This Scottish Intercollegiate Guidelines Network and British Thoracic Society guideline provides recommendations based on current evidence for best practice in the management of asthma of adults, including pregnant women, and adolescents and children with asthma
These practice parameters were developed by the American Academy of Allergy, Asthma & Immunology (AAAAI), the American College of Allergy, Asthma & Immunology (ACAAI) and the Joint Council of Allergy, Asthma & Immunology.
2014. International guidelines on the definition, evaluation and treatment of severe asthma (ERS/ATS)
European Respiratory Society and American Thoracic Society (ATS) guidelines on severe asthma including an updated definition, a discussion of severe asthma phenotypes in relation to genetics, natural history, pathobiology and physiology, as well as recommendations on evaluation and treatment.
Fractional exhaled nitric oxide (FeNO) testing is recommended by the UK National Institute for Health and Clinical Excellence to help diagnose asthma in adults and children who have an intermediate probability of having asthma and in combination with other diagnostic options as a negative result does not exclude asthma. It is also recommended as an option to support asthma management in people who are symptomatic despite using inhaled corticosteroids.
Omalizumab is recommended as an option for treating severe persistent confirmed allergic IgE-mediated asthma as an add-on to optimised standard therapy in people aged 6 years and older who need continuous or frequent treatment with oral corticosteroids (defined as 4 or more courses in the previous year), and if the manufacturer makes Omalizumab available with the discount agreed in the patient access scheme.
This quality standard from the UK National Institute for Health and Clinical Excellence covers the diagnosis and treatment of asthma in adults, young people and children aged 12 months and older.
American Thoracic Society guideline on exercise-induced bronchoconstriction (EIB); acute airway narrowing that occurs as a result of exercise and is present in a substantial proportion of patients with asthma, but may also
occur in individuals without known asthma.
European Respiratory society guidelines on Work-related asthma, which includes occupational asthma and work-aggravated asthma.
The U.K. National Institute for Health and Clinical Excellence (NICE) interventional procedure guidance. Evidence on the efficacy of bronchial thermoplasty for severe asthma shows some improvement in symptoms and quality of life, reduced exacerbations and admission to hospital. Evidence on safety is adequate in the short and medium term. More evidence is required on long term safety.
Canadian Thoracic Society 2012 guideline update: Diagnosis and management of asthma in preschoolers, children and adults
American Thoracic Society (ATS) Statement on Work Exacerbated Asthma. Work Exacerbated Asthma (WEA) is the worsening of asthma due to conditions at work. This statement outlines the epidemiology, clinical characteristics and management of WEA. WEA should be considered in any patient with asthma whose symptoms are deteriorating or who has work related symptoms.
An American Thoracic Society (ATS) Report of a Workshop on Asthma and Obesity. Obesity is a risk factor for the development of asthma. Asthma in obese individuals tends to be more severe and does not respond as well to treatment. The developed world is facing an epidemic of obesity and therefore Obesity and Asthma is becoming a significant major public health issue in many countries.