title: Approach to Patients with Severe Asthma: a Consensus Statement from the Respiratory Care Experts' Input Forum (RC-EIF), Iran.
abstract: Challenges in the assessment, diagnosis and management of severe, difficult-to-control asthma are increasingly regarded as clinical needs yet unmet. The assessments required to determine asthma severity, comorbidities and confounding factors, disease phenotypes and optimal treatment are among the controversial issues in the field. The respiratory care experts' input forum (RC-EIF), comprised of an Iranian panel of experts, reviewed the definition, appraised the available guidelines and provided a consensus for evaluation and treatment of severe asthma in adults. A systematic literature review followed by discussions during and after the forum, yielded the present consensus. The expert panel used the appraisal of guidelines for research and evaluation-II (AGREE-II) protocol to define an initial locally-adapted strategy for the management of severe asthma. Severe asthma is considered a heterogeneous condition with various phenotypes. Issues such as assessment of difficult-to-control asthma, phenotyping, the use of blood and sputum eosinophil count, exhaled nitric oxide to guide therapy, the position of anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty as well as the use of established, recently-developed and evolving treatment approaches were discussed and unanimously agreed upon in the panel. A systematic approach is required to ensure proper diagnosis, evaluate compliance, and to identify comorbidities and triggering factors in severe asthma. Phenotyping helps select optimized treatment. The treatment approach laid down by the Global Initiative for Asthma (GINA) needs to be followed, while the benefit of using biological therapies should be weighed against the cost and safety concerns.
authors.affiliation: Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Khalil
authors.initials: K
authors.lastname: Ansarin
authors.affiliation: Lung Disease Research Center, Mashhad University of Medical Science, Mashhad, Iran.
authors.forename: Davood
authors.initials: D
authors.lastname: Attaran
authors.affiliation: Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Jamaati
authors.affiliation: Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Masjedi
authors.affiliation: Advanced Thoracic Research Center, Pulmonary and Critical Care Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Abtahi
authors.affiliation: Department of Pulmonology, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Alavi
authors.affiliation: Department of Internal Medicine, Pulmonary and Critical Care Division, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Aliyali
authors.affiliation: Lung Disease Research Center, Mashhad University of Medical Science, Mashhad, Iran.
authors.forename: Amir Mohammad Hashem
authors.initials: AM
authors.lastname: Asnaashari
authors.affiliation: Allergy Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Farid-Hosseini
authors.affiliation: Department of Internal Medicine, Division of Pulmonology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Seyyed Mohammad Ali
authors.initials: SM
authors.lastname: Ghayumi
authors.affiliation: Department of Internal Medicine, Pulmonary Division, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
authors.forename: Hassan
authors.initials: H
authors.lastname: Ghobadi
authors.affiliation: Behphar Scientific Committee, Behphar Group, Tehran, Iran.
authors.forename: Atabak
authors.initials: A
authors.lastname: Ghotb
authors.affiliation: Respiratory-Care Experts' Input Forum, Mortaz Hospital, Yazd, Iran.
authors.forename: Abolhassan
authors.initials: A
authors.lastname: Halvani
authors.affiliation: Department of Pulmonology, Artesh University of Medical Sciences, Tehran, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Nemati
authors.affiliation: Department of Pulmonary Medicine, Imam Khomeini hospital, Urmia University of Medical Sciences, Urmia, Iran.
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Rahimi Rad
authors.affiliation: Department of Internal medicine, Division of Pulmonary and Critical Care Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Rahimian
authors.affiliation: Department of Pulmonary Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
authors.forename: Ramin
authors.initials: R
authors.lastname: Sami
authors.affiliation: Department of Pulmonary Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Sohrabpour
authors.affiliation: Clinical Research & Development Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Sasan
authors.initials: S
authors.lastname: Tavana
authors.affiliation: Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran ; Behphar Scientific Committee, Behphar Group, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Torabi-Nami
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Parviz
authors.initials: P
authors.lastname: Vahedi
keywords: Comorbidities; Consensus statement; Definition; Iran; Phenotyping; Severe asthma; Treatment