title: Managing severe asthma in adults: lessons from the ERS/ATS guidelines.
abstract: OBJECTIVE
  To review the latest guidelines on severe asthma.
  
  
  RESULTS
  An updated definition of severe asthma is provided together with the evaluation steps necessary to reach a diagnosis of severe asthma. The importance of phenotyping is emphasized, and recommendations are provided for therapies specifically directed for severe asthma.
  
  
  CONCLUSIONS
  Severe asthma is widely recognized as a major unmet need. It is defined as asthma that requires treatment with high-dose inhaled corticosteroids and a second controller and/or systemic corticosteroid to prevent it from becoming 'uncontrolled' or that remains 'uncontrolled' despite this therapy. Severe asthma is a heterogeneous condition that consists of phenotypes such as eosinophilic asthma. More phenotypes need to be defined. Evaluation of the patient referred to as having severe or difficult-to-control asthma must take into account adherence to treatment, comorbidities and associated factors including side effects from therapies. These need to be addressed. Recommendations on the use of sputum eosinophil count and exhaled nitric oxide to guide therapy are presented. Treatment with anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty is reviewed and recommendations made. Research efforts into phenotyping of severe asthma will provide both biomarker-driven approaches and newer effective therapies to severe asthma management.
authors.affiliation: aExperimental Studies, National Heart and Lung Institute, Imperial College London bNIHR Respiratory Biomedical Research Unit at the Royal Brompton NHS Foundation Trust and Imperial College London, London, UK.
authors.forename: Kian Fan
authors.initials: KF
authors.lastname: Chung
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology; D015415:Biomarkers / Q000378:metabolism; D015897:Comorbidity; D000075202:Contraindications; D006801:Humans; D007166:Immunosuppressive Agents; D008727:Methotrexate; D009569:Nitric Oxide / Q000276:immunology*; D010641:Phenotype; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012720:Severity of Illness Index; D013183:Sputum / Q000276:immunology*
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D015415:Biomarkers; D007166:Immunosuppressive Agents; D009569:Nitric Oxide; D008727:Methotrexate