Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline

Holguin, Fernando and Cardet, Juan Carlos and Chung, Kian Fan and Diver, Sarah and Ferreira, Diogenes S. and Fitzpatrick, Anne and Gaga, Mina and Kellermeyer, Liz and Khurana, Sandhya and Knight, Shandra and McDonald, Vanessa M. and Morgan, Rebecca L. and Ortega, Victor E. and Rigau, David and Subbarao, Padmaja and Tonia, Thomy and Adcock, Ian M. and Bleecker, Eugene R. and Brightling, Chris and Boulet, Louis-Philippe and Cabana, Michael and Castro, Mario and Chanez, Pascal and Custovic, Adnan and Djukanovic, Ratko and Frey, Urs and Frankemölle, Betty and Gibson, Peter and Hamerlijnck, Dominique and Jarjour, Nizar and Konno, Satoshi and Shen, Huahao and Vitary, Cathy and Bush, Andy. (2020) Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline. European Respiratory Journal, 55 (1). p. 1900588.

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This document provides clinical recommendations for the management of severe asthma. Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the European Respiratory Society/American Thoracic Society Task Force's questions. The evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of asthma experts, who made specific recommendations on six specific questions. After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made the following recommendations: 1) suggest using anti-interleukin (IL)-5 and anti-IL-5 receptor α for severe uncontrolled adult eosinophilic asthma phenotypes; 2) suggest using a blood eosinophil cut-point ≥150 μL; -1; to guide anti-IL-5 initiation in adult patients with severe asthma; 3) suggest 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) suggest using inhaled tiotropium for adolescents and adults with severe uncontrolled asthma despite Global Initiative for Asthma (GINA) step 4-5 or National Asthma Education and Prevention Program (NAEPP) step 5 therapies; 5) suggest a trial of chronic macrolide therapy to reduce asthma exacerbations in persistently symptomatic or uncontrolled patients on GINA step 5 or NAEPP step 5 therapies, irrespective of asthma phenotype; and 6) suggest 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. These recommendations should be reconsidered as new evidence becomes available.
Faculties and Departments:03 Faculty of Medicine > Bereich Kinder- und Jugendheilkunde (Klinik) > Kinder- und Jugendheilkunde (UKBB) > Pädiatrie (Frey)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Kinder- und Jugendheilkunde (Klinik) > Kinder- und Jugendheilkunde (UKBB) > Pädiatrie (Frey)
UniBasel Contributors:Frey, Urs Peter
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:European Respiratory Society
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:03 Mar 2021 15:31
Deposited On:03 Mar 2021 09:18

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