Expert opinion on diagnosis and management of Severe Asthma in low and middle income countries (LMIC) with focus on India

Abstract

Objective

In this document, 9 Indian experts have evaluated the factors specific to LMICs when it came to Severe Asthma (SA) diagnosis, evaluation, biologic selection, non-biologic treatment options, and follow-up.

Data sources

A search was performed using 50 keywords, focusing on the Indian/LMICs perspective, in PubMed, Cochrane Library, and Google Scholar. The key areas of the search were focused on diagnosis, phenoendotyping, non-biological therapies, selecting a biologic, assessment of treatment response, and management of exacerbation.

Study selections

The initial search revealed 1826 articles, from these case reports, observational studies, cohort studies, non-English language papers, etc., were excluded and we short-listed 20 articles for each area. Five relevant articles were selected by the experts for review.

Results

In LMICs, SA patients may be referred to the specialist for evaluation a little late for Phenoendotyping of SA. While biologic therapy is now a standard of care, pulmonologists in LMICs may not have access to all the investigations to phenoendotype SA patients like fractional exhaled nitric oxide (FeNO), skin prick test (SPT), etc., but phenotyping of SA patients can also be done with simple blood investigations, eosinophil count and serum immunoglobulin E (IgE). Choosing a biologic in the overlapping phenotype of SA and ACO patients is also a challenge in the LMICs.

Conclusions

Given the limitations of LMIC, it is important to select the right patient and explain the potential benefits of biological therapy. Non-biologic add-on therapies can be attempted in a resource-limited setting where biological therapy is not available/feasible for patients.

Keywords:

• Severe asthma
• phenotypes
• anti-IgE
• anti-IL5
• anti-IL4
• India
• LMIC

Acknowledgements

The authors acknowledge Exicon consulting/Dr Sonam Solanki/Dr Salman Rizvi, India for the medical writing support provided for the manuscript.

Meeting facilitation in the form of bringing the experts together and writing assistance under the direction and guidance of the experts, collating and incorporating authors’ comments was provided by Exicon.

Declaration of patient consent

Patient consent not required as there are no patients in this study.

Declaration of interest

There are no conflicts of interest.

Additional information

Funding

GSK has given scientific and financial support for the medical writing of this scientific ad board.