Immunomodulatory and biologic therapies for severe refractory asthma.
Despite undoubted efficacy of the combination of inhaled corticosteroids and beta(2)-agonists for most asthmatic patients with moderate-to-severe disease, there remains approximately 10% of the asthmatic population with serious unremitting symptoms, resulting in considerable impact on quality of life, disproportionate use of health care resources, and adverse effects from regular systemic steroid use. In an ideal world, optimal treatment of severe refractory asthma should achieve the best possible asthma control and quality of life with the least dose of systemic corticosteroids. The choice and formulation of therapeutic agent are dictated by the severity of disease and may include immunological modifiers and biologic therapies. Unfortunately, current asthma guidelines offer little contribution to the management of the challenging patient with severe refractory asthma and none of them have addressed therapeutic alternatives to oral corticosteroids. This article reviews the current evidence for immunomodulating and biologic approaches in severe refractory asthma.
Polosa
Riccardo
R
Ospedale Santa Marta, U.O.C di Medicina Interna e Medicina d'Urgenza, Via Gesualdo Clementi 36, 95124 Catania, Italy. polosa@unict.it
Morjaria
Jaymin
J
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001249:Asthma / Q000503:physiopathology / Q000628:therapy*; D001691:Biological Therapy / Q000009:adverse effects / Q000379:methods*; D002908:Chronic Disease / Q000188:drug therapy; D002985:Clinical Protocols; D004305:Dose-Response Relationship, Drug; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D012720:Severity of Illness Index; D017211:Treatment Failure
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D007155:Immunologic Factors