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The mechanisms, diagnosis, and management of severe asthma in adults

The mechanisms, diagnosis, and management of severe asthma in adults
The mechanisms, diagnosis, and management of severe asthma in adults
There has been a recent increase in the prevalence of asthma worldwide; however, the 5-10% of patients with severe disease account for a substantial proportion of the health costs. Although most asthma cases can be satisfactorily managed with a combination of anti-inflammatory drugs and bronchodilators, patients who remain symptomatic despite maximum combination treatment represent a heterogeneous group consisting of those who are under-treated or non-adherent with their prescribed medication. After excluding under-treatment and poor compliance, corticosteroid refractory asthma can be identified as a subphenotype characterised by a heightened neutrophilic airway inflammatory response in the presence or absence of eosinophils, with evidence of increased tissue injury and remodelling. Although a wide range of environmental factors such as allergens, smoking, air pollution, infection, hormones, and specific drugs can contribute to this phenotype, other features associated with changes in the airway inflammatory response should be taken into account. Aberrant communication between an injured airway epithelium and underlying mesenchyme contributes to disease chronicity and refractoriness to corticosteroids. The importance of identifying underlying causative factors and the recent introduction of novel therapeutic approaches, including the targeting of immunoglobulin E and tumour necrosis factor alpha with biological agents, emphasise the need for careful phenotyping of patients with severe disease to target improved management of the individual patient's needs.
0140-6736
780-793
Holgate, Stephen T.
2e7c17a9-6796-436e-8772-1fe6d2ac5edc
Polosa, Riccardo
8eaf4eb4-d2fc-4e22-b6c7-e9a2e28d95ec
Holgate, Stephen T.
2e7c17a9-6796-436e-8772-1fe6d2ac5edc
Polosa, Riccardo
8eaf4eb4-d2fc-4e22-b6c7-e9a2e28d95ec

Holgate, Stephen T. and Polosa, Riccardo (2006) The mechanisms, diagnosis, and management of severe asthma in adults. The Lancet, 368 (9537), 780-793. (doi:10.1016/S0140-6736(06)69288-X).

Record type: Article

Abstract

There has been a recent increase in the prevalence of asthma worldwide; however, the 5-10% of patients with severe disease account for a substantial proportion of the health costs. Although most asthma cases can be satisfactorily managed with a combination of anti-inflammatory drugs and bronchodilators, patients who remain symptomatic despite maximum combination treatment represent a heterogeneous group consisting of those who are under-treated or non-adherent with their prescribed medication. After excluding under-treatment and poor compliance, corticosteroid refractory asthma can be identified as a subphenotype characterised by a heightened neutrophilic airway inflammatory response in the presence or absence of eosinophils, with evidence of increased tissue injury and remodelling. Although a wide range of environmental factors such as allergens, smoking, air pollution, infection, hormones, and specific drugs can contribute to this phenotype, other features associated with changes in the airway inflammatory response should be taken into account. Aberrant communication between an injured airway epithelium and underlying mesenchyme contributes to disease chronicity and refractoriness to corticosteroids. The importance of identifying underlying causative factors and the recent introduction of novel therapeutic approaches, including the targeting of immunoglobulin E and tumour necrosis factor alpha with biological agents, emphasise the need for careful phenotyping of patients with severe disease to target improved management of the individual patient's needs.

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More information

Published date: 1 September 2006
Organisations: Infection Inflammation & Immunity

Identifiers

Local EPrints ID: 59317
URI: http://eprints.soton.ac.uk/id/eprint/59317
ISSN: 0140-6736
PURE UUID: 2a2ab027-cb7d-4809-a564-963745647542

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Date deposited: 02 Sep 2008
Last modified: 15 Mar 2024 11:15

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Author: Riccardo Polosa

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