title: Refractory asthma - beyond step 5, the role of new and emerging adjuvant therapies.
abstract: A small percentage of asthmatics have 'severe refractory asthma', where there is suboptimal response to currently available therapies. A number of novel therapies targeting key biological targets are becoming available. Asthma is a heterogeneous disease, and systematic evaluation of patients is important to target therapies to the underlying inflammatory subtype and clinical features. This review article outlines new and emerging treatments for severe asthma, including monoclonal antibodies targeting eosinophilic disease, anti-neutrophil strategies, novel bronchodilators and bronchial thermoplasty. We highlight the importance of individualized investigation, treatment and management of severe asthmatics.
authors.affiliation: Manchester Academic Health Science Centre, University Hospital of South Manchester, University of Manchester, Southmoor Road, Manchester, UK binita.kane@doctors.org.uk.
authors.forename: Binita
authors.initials: B
authors.lastname: Kane
authors.affiliation: Manchester Academic Health Science Centre, University Hospital of South Manchester, University of Manchester, Southmoor Road, Manchester, UK Respiratory Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Fowler
authors.affiliation: Manchester Academic Health Science Centre, University Hospital of South Manchester, University of Manchester, Southmoor Road, Manchester, UK.
authors.forename: Rob
authors.initials: R
authors.lastname: Niven
mesh_terms: D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D000888:Antibodies, Anti-Idiotypic / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001249:Asthma / Q000628:therapy*; D001980:Bronchi / Q000601:surgery*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D001999:Bronchoscopy / Q000379:methods; D005658:Fungi / Q000276:immunology; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy / Q000276:immunology; D006979:Hyperthermia, Induced / Q000379:methods*; D015847:Interleukin-4 / Q000627:therapeutic use; D017964:Itraconazole / Q000627:therapeutic use; D018942:Macrolides / Q000627:therapeutic use; D000069444:Omalizumab; D058988:Phosphodiesterase 4 Inhibitors / Q000627:therapeutic use; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018927:Anti-Asthmatic Agents; D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000935:Antifungal Agents; D001993:Bronchodilator Agents; D018942:Macrolides; D058988:Phosphodiesterase 4 Inhibitors; D014409:Tumor Necrosis Factor-alpha; C559987:pitrakinra; D015847:Interleukin-4; D000069444:Omalizumab; D017964:Itraconazole; C582203:dupilumab; C434107:mepolizumab; C574065:tralokinumab; C561806:lebrikizumab
keywords: Refractory; asthma; novel; therapy