title: Pharmacotherapy of critical asthma syndrome: current and emerging therapies.
abstract: The critical asthma syndrome (CAS) encompasses the most severe, persistent, refractory asthma patients for the clinician to manage. Personalized pharmacotherapy is necessary to prevent the next acute severe asthma exacerbation, not just the control of symptoms. The 2007 National Asthma Education and Prevention Program Expert Panel 3 provides guidelines for the treatment of uncontrolled asthma. The patient's response to recommended pharmacotherapy is highly variable which risks poor asthma control leading to frequent exacerbations that can deteriorate into CAS. Controlling asthma symptoms and preventing acute exacerbations may be two separate clinical activities with their own unique demands. Clinicians must be prepared to use the entire spectrum of asthma medications available but must concurrently be aware of potential drug toxicities some of which can paradoxically worsen asthma control. Medications normally prescribed for COPD can potentially be useful in the CAS patient, particularly those with asthma-COPD overlap syndrome. Immunomodulation with drugs like omalizumab in IgE-mediated asthma syndromes is one important approach. New and emerging drugs address unique aspects of airway inflammation and biology but at a significant financial cost. The pharmacology and toxicities of the agents that may be used in the treatment of CAS to control asthma symptoms and prevent severe exacerbations are reviewed.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA, 95817, USA, tealbertson@ucdavis.edu.
authors.forename: T E
authors.initials: TE
authors.lastname: Albertson
authors.forename: M
authors.initials: M
authors.lastname: Schivo
authors.forename: N
authors.initials: N
authors.lastname: Gidwani
authors.forename: N J
authors.initials: NJ
authors.lastname: Kenyon
authors.forename: M E
authors.initials: ME
authors.lastname: Sutter
authors.forename: A L
authors.initials: AL
authors.lastname: Chan
authors.forename: S
authors.initials: S
authors.lastname: Louie
mesh_terms: D000818:Animals; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D000888:Antibodies, Anti-Idiotypic / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D016638:Critical Illness; D004358:Drug Therapy / Q000639:trends; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology / Q000378:metabolism; D056747:Immunomodulation; D000069444:Omalizumab; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012137:Respiratory System / Q000187:drug effects* / Q000276:immunology; D013577:Syndrome
chemical_list: D018927:Anti-Asthmatic Agents; D000888:Antibodies, Anti-Idiotypic; D061067:Antibodies, Monoclonal, Humanized; D000069444:Omalizumab; D007073:Immunoglobulin E