title: International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma.
abstract: Severe or therapy-resistant asthma is increasingly recognised as a major unmet need. A Task Force, supported by the European Respiratory Society and American Thoracic Society, reviewed the definition and provided recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults. A literature review was performed, followed by discussion by an expert committee according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach for development of specific clinical recommendations. When the diagnosis of asthma is confirmed and comorbidities addressed, severe asthma is defined as asthma that requires treatment with high dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming "uncontrolled" or that remains "uncontrolled" despite this therapy. Severe asthma is a heterogeneous condition consisting of phenotypes such as eosinophilic asthma. Specific recommendations on the use of sputum eosinophil count and exhaled nitric oxide to guide therapy, as well as treatment with anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty are provided. Coordinated research efforts for improved phenotyping will provide safe and effective biomarker-driven approaches to severe asthma therapy.
authors: Imperial College, London.
authors: Kian Fan
authors: KF
authors: Chung
authors: Sally E
authors: SE
authors: Wenzel
authors: Jan L
authors: JL
authors: Brozek
authors: Andrew
authors: A
authors: Bush
authors: Mario
authors: M
authors: Castro
authors: Peter J
authors: PJ
authors: Sterk
authors: Ian M
authors: IM
authors: Adcock
authors: Eric D
authors: ED
authors: Bateman
authors: Elisabeth H
authors: EH
authors: Bel
authors: Eugene R
authors: ER
authors: Bleecker
authors: Louis-Philippe
authors: LP
authors: Boulet
authors: Christopher
authors: C
authors: Brightling
authors: Pascal
authors: P
authors: Chanez
authors: Sven-Erik
authors: SE
authors: Dahlen
authors: Ratko
authors: R
authors: Djukanovic
authors: Urs
authors: U
authors: Frey
authors: Mina
authors: M
authors: Gaga
authors: Peter
authors: P
authors: Gibson
authors: Qutayba
authors: Q
authors: Hamid
authors: Nizar N
authors: NN
authors: Jajour
authors: Thais
authors: T
authors: Mauad
authors: Ronald L
authors: RL
authors: Sorkness
authors: W Gerald
authors: WG
authors: Teague
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis* / Q000628:therapy*; D015415:Biomarkers; D002986:Clinical Trials as Topic; D015897:Comorbidity; D006801:Humans; D007107:Immune System; D007073:Immunoglobulin E / Q000276:immunology; D007391:International Cooperation; D010641:Phenotype; D017410:Practice Guidelines as Topic; D015272:Pulmonary Medicine / Q000379:methods / Q000592:standards*; D012307:Risk Factors
chemical_list: D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D007073:Immunoglobulin E