title: Severe asthma: Current management, targeted therapies and future directions-A roundtable report.
abstract: Asthma is a chronic respiratory disease characterized by respiratory symptoms, airway inflammation, airway obstruction and airway hyper-responsiveness. Asthma is common and directly affects 10% of Australians, 1-5% of adults in Asia and 300 million people worldwide. It is a heterogeneous disorder with many clinical, molecular, biological and pathophysiological phenotypes. Current management strategies successfully treat the majority of patients with asthma who have access to them. However, there is a subset of an estimated 5-10% of patients with asthma who have severe disease and are disproportionately impacted by symptoms, exacerbations and overall illness burden. The care required for this relatively small proportion of patients is also significant and has a major impact on the healthcare system. A number of new therapies that hold promise for severe asthma are currently in clinical trials or are entering the Australian and international market. However, recognition of severe asthma in clinical practice is variable, and there is little consensus on the best models of care or how to integrate emerging and often costly therapies into current practice. In this article, we report on roundtable discussions held with severe asthma experts from around Australia, and make recommendations about approaches for better patient diagnosis and assessment. We assess current models of care for patient management and discuss how approaches may be optimized to improve patient outcomes. Finally, we propose mechanisms to assess new therapies and how to best integrate these approaches into future treatment.
authors.affiliation: National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, New South Wales, Australia.|Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, New South Wales, Australia.|Hunter Medical Research Institute, Newcastle, New South Wales, Australia.|Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: McDonald
authors.affiliation: National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, New South Wales, Australia.|Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, New South Wales, Australia.|Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
authors.forename: Steven
authors.initials: S
authors.lastname: Maltby
authors.affiliation: National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, New South Wales, Australia.|Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Helen K
authors.identifier: 0000-0002-6695-6350
authors.initials: HK
authors.lastname: Reddel
authors.affiliation: National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, New South Wales, Australia.|Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Gregory G
authors.initials: GG
authors.lastname: King
authors.affiliation: National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, New South Wales, Australia.|Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, New South Wales, Australia.|Hunter Medical Research Institute, Newcastle, New South Wales, Australia.|Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Peter A B
authors.initials: PA
authors.lastname: Wark
authors.affiliation: National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, New South Wales, Australia.|The University of Sydney Faculty of Pharmacy, Sydney, New South Wales, Australia.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Smith
authors.affiliation: National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, New South Wales, Australia.|Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: John W
authors.initials: JW
authors.lastname: Upham
authors.affiliation: National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, New South Wales, Australia.|Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.|School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Alan L
authors.initials: AL
authors.lastname: James
authors.affiliation: National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, New South Wales, Australia.|Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.|South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia.
authors.forename: Guy B
authors.initials: GB
authors.lastname: Marks
authors.affiliation: National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, New South Wales, Australia.|Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, New South Wales, Australia.|Hunter Medical Research Institute, Newcastle, New South Wales, Australia.|Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Gibson
mesh_terms: D001249:Asthma / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D019468:Disease Management; D006801:Humans; D012720:Severity of Illness Index
keywords: asthma; co-morbidity; multidimensional assessment; quality of life; targeted therapy