Moving toward consensus on diagnosis and management of severe asthma in adults

Abstract

Asthma is a considerable health problem with an increasing global prevalence. The burden of severe asthma is expected to notably increase in the following years. Some misleading concepts that sometimes appear in the literature can drive the physician responsible for a patient’s management to make incorrect decisions. Furthermore, some of the concepts that appear in the literature and in the guidelines may not be clear to understand, follow or adapt to regional and local realities. This could again drive the physicians responsible for a patient’s management to make incorrect clinical judgments. In this article, we review the definition, prevalence and immunopathology of severe asthma, describe the asthma phenotypes, clinical features and comorbidities, the diagnosis of severe asthma and personalized asthma treatment. At the end, we offer a treatment approach based on literature publications, personalized medicine and marketed biologic treatment options.

Keywords:

• Consensus
• diagnosis
• disease management
• severe asthma
• treatment

Transparency

Declaration of funding

This work was funded by Novartis Pharma AG, Basel, Switzerland.

Author contributions: All authors were involved in the conception and design, or analysis and interpretation of the data; the drafting of the manuscript, and revising it critically for intellectual content. All authors approved the final approval of the version to be published. All authors agree to be accountable for all aspects of this work.

Declaration of financial/other relationships

D.C. has disclosed that he has served on advisory boards, speaker panels, or received travel reimbursement for Altana, AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Merck (Schering-Plough), Novartis, and Teva; he has received research, consulting, and lecturing fees from GlaxoSmithKline, Schering-Plough, Altana, AstraZeneca, Merck, Novartis, Boehringer-Ingelheim, Teva, and Phoenix. O.P. has disclosed that he has received research grants from Inmunotek SL; payment for lectures from Inmunotek SL, Stallergenes, Allergy Therapeutics, AstraZeneca, and Novartis; and has participated in advisory boards for Novartis, and Sanofi Genzyme. C.C. has disclosed that he has served on advisory boards, speaker panels or received consulting and lecturing fees from GlaxoSmithKline, AstraZeneca, and Novartis Colombia. A.K. has disclosed that he has served on advisory boards, speaker panels, or received travel reimbursement for AstraZeneca, Boehringer-Ingelheim, Griffols, GlaxoSmithKline, Mylan, Novartis, Sanofi, Teva, and Trudell. C.D. has disclosed that he has served on advisory boards, speaker panels and or received lecturing fees and travel reimbursement for AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck (Schering-Plough), Novartis, Sanofi Aventis, Menarini, Chiesi, Pfizer, Teva, Esteve, Ferrer, Rovi, ALK, Stallergens, Immunotek, Allergy terapeutics, Hal Allergy, and Leti; during the last 5 years, he has conducted multicenter clinical research trials for GlaxoSmithKline, Sanofi-Aventis, TEVA, and Novartis.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

The authors thank Rahul Lad PhD and Praveen Kaul PhD of Novartis for providing medical writing support, which was funded by Novartis Pharma AG in accordance with Good Publication Practice (GPP3) guidelines.

Notes

1 Xolair is a registered trade name of Genentech USA, Inc. San Francisco, CA, United States and Novartis Pharma AG, Basel, Switzerland

2 Nucala is a registered trade name of GSK, Brentford, United Kingdom

3 Cinqair, Cinqaero are registered trade names of Teva Pharmaceuticals, Petah Tikva, Israel