title: Challeges in the management of severe asthma: role of current and future therapies.
abstract: Severe asthma is a complex and heterogeneous phenotype characterized by persistent symptoms and poor control. While some patients respond to high doses of inhaled corticosteroids in combination with long-acting beta-agonists, a significant subset require oral corticosteroids to achieve symptom control. This issue has led to the development of alternative therapeutic strategies for severe asthma. This article provides an overview of current therapeutic strategies and suggests how they can be best applied to the treatment of severe asthma. The article then reviews alternative therapeutic strategies including macrolide antibiotics, biologic agents, modulators of signal transduction pathways and bronchial thermoplasty. The challenge remains to determine the appropriate phenotype for each therapeutic strategy in view of the heterogeneity of severe asthma.
authors.affiliation: Meakins-Christie Laboratories, McGill University, Montreal, Canada.
authors.forename: Ron
authors.initials: R
authors.lastname: Oliveinstein
authors.forename: Hamdan
authors.initials: H
authors.lastname: Al Jahdali
authors.forename: Nouf
authors.initials: N
authors.lastname: Alkhamis
authors.forename: Rabih
authors.initials: R
authors.lastname: Halwani
authors.forename: Saleh
authors.initials: S
authors.lastname: Al-Muhsen
authors.forename: Qutayba
authors.initials: Q
authors.lastname: Hamid
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000818:Animals; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D019468:Disease Management; D004359:Drug Therapy, Combination; D005544:Forecasting; D006801:Humans; D018942:Macrolides / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic / Q000639:trends; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D018942:Macrolides