Severe asthma: approach and management.
Management of severe asthma remains a significant challenge. Patients with this condition do not respond adequately to inhaled corticosteroids and bronchodilators, forcing a search for alternative strategies. The clinician's initial priority is to firmly establish the diagnosis of severe asthma, as many conditions can mimic and/or aggravate this disease. Once the diagnosis is confirmed and confounding variables addressed, a variety of pharmacological and non-pharmacological approaches must be considered. Continuous use of oral corticosteroids carries a risk of significant adverse effects. Leukotriene modifiers and antibodies to IgE are effective for some patients but not for many others. Alternative anti-inflammatory drugs and novel or unconventional modalities may also be used. Although severe asthma remains a clinical dilemma, a rational diagnostic and therapeutic strategy can be used to improve patient outcomes.
Reddy
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RC
University of Michigan Medical Center, Division of Pulmonary and Critical Care Medicine, 109 Zina Pitcher Place, 4062 BSRB, Ann Arbor, MI 48109-2200, USA. rajuc@umich.edu
D000485:Allergens / Q000009:adverse effects; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D002908:Chronic Disease; D015897:Comorbidity; D004351:Drug Resistance; D006801:Humans; D016273:Occupational Exposure / Q000009:adverse effects; D010349:Patient Compliance
D000485:Allergens; D018927:Anti-Asthmatic Agents