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Severe asthma in adults: what are the important questions?

Severe asthma in adults: what are the important questions?
Severe asthma in adults: what are the important questions?
The term severe refractory asthma (SRA) in adults applies to patients who remain difficult to control despite extensive re-evaluation of diagnosis and management following an observational period of at least 6 months by a specialist. Factors that influence asthma control should be recognized and adequately addressed prior to confirming the diagnosis of SRA. This report presents statements according to the literature defining SRA in order address the important questions. Phenotyping SRA will improve our understanding of mechanisms, natural history, and prognosis. Female gender, obesity, and smoking are associated with SRA. Atopy is less frequent in SRA, but occupational sensitizers are common inducers of new-onset SRA. Viruses contribute to severe exacerbations and can persist in the airways for long periods. Inflammatory cells are in the airways of the majority of patients with SRA and persist despite steroid therapy. The T(H)2 immune process alone is inadequate to explain SRA. Reduced responsiveness to corticosteroids is common, and epithelial cell and smooth muscle abnormalities are found, contributing to airway narrowing. Large and small airway wall thickening is observed, but parenchymal abnormalities may influence airway limitation. Inhaled corticosteroids and bronchodilators are the mainstay of treatment, but patients with SRA remain uncontrolled, indicating a need for new therapies.
epidemiology, pathophysiology, management, research perspectives, severe asthma
0091-6749
1337-1348
Chanez, Pascal
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Wenzel, Sally E.
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Anderson, Gary P.
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Anto, Josep M.
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Bel, Elisabeth H.
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Boulet, Louis-Philippe
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Brightling, Christopher E.
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Busse, William W.
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Castro, Mario
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Dahlen, Babro
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Dahlen, Sven Erik
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Fabbri, Leo M.
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Holgate, Stephen T.
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Humbert, Marc
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Gaga, Mina
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Joos, Guy F.
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Levy, Bruce
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Rabe, Klaus F.
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Sterk, Peter J.
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Wilson, Susan J.
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Vachier, Isabelle
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Chanez, Pascal
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Wenzel, Sally E.
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Anderson, Gary P.
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Anto, Josep M.
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Bel, Elisabeth H.
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Boulet, Louis-Philippe
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Brightling, Christopher E.
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Busse, William W.
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Castro, Mario
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Dahlen, Babro
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Dahlen, Sven Erik
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Fabbri, Leo M.
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Holgate, Stephen T.
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Humbert, Marc
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Gaga, Mina
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Joos, Guy F.
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Levy, Bruce
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Rabe, Klaus F.
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Sterk, Peter J.
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Wilson, Susan J.
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Vachier, Isabelle
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Chanez, Pascal, Wenzel, Sally E., Anderson, Gary P., Anto, Josep M., Bel, Elisabeth H., Boulet, Louis-Philippe, Brightling, Christopher E., Busse, William W., Castro, Mario, Dahlen, Babro, Dahlen, Sven Erik, Fabbri, Leo M., Holgate, Stephen T., Humbert, Marc, Gaga, Mina, Joos, Guy F., Levy, Bruce, Rabe, Klaus F., Sterk, Peter J., Wilson, Susan J. and Vachier, Isabelle (2007) Severe asthma in adults: what are the important questions? Journal of Allergy and Clinical Immunology, 119 (6), 1337-1348. (doi:10.1016/j.jaci.2006.11.702). (PMID:17416409)

Record type: Article

Abstract

The term severe refractory asthma (SRA) in adults applies to patients who remain difficult to control despite extensive re-evaluation of diagnosis and management following an observational period of at least 6 months by a specialist. Factors that influence asthma control should be recognized and adequately addressed prior to confirming the diagnosis of SRA. This report presents statements according to the literature defining SRA in order address the important questions. Phenotyping SRA will improve our understanding of mechanisms, natural history, and prognosis. Female gender, obesity, and smoking are associated with SRA. Atopy is less frequent in SRA, but occupational sensitizers are common inducers of new-onset SRA. Viruses contribute to severe exacerbations and can persist in the airways for long periods. Inflammatory cells are in the airways of the majority of patients with SRA and persist despite steroid therapy. The T(H)2 immune process alone is inadequate to explain SRA. Reduced responsiveness to corticosteroids is common, and epithelial cell and smooth muscle abnormalities are found, contributing to airway narrowing. Large and small airway wall thickening is observed, but parenchymal abnormalities may influence airway limitation. Inhaled corticosteroids and bronchodilators are the mainstay of treatment, but patients with SRA remain uncontrolled, indicating a need for new therapies.

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Published date: June 2007
Keywords: epidemiology, pathophysiology, management, research perspectives, severe asthma

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Local EPrints ID: 190903
URI: https://eprints.soton.ac.uk/id/eprint/190903
ISSN: 0091-6749
PURE UUID: 48e9fe71-d0ef-45d3-8bd2-a0ea0b501e0e

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Date deposited: 15 Jun 2011 15:30
Last modified: 16 Jul 2019 23:27

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Contributors

Author: Pascal Chanez
Author: Sally E. Wenzel
Author: Gary P. Anderson
Author: Josep M. Anto
Author: Elisabeth H. Bel
Author: Louis-Philippe Boulet
Author: Christopher E. Brightling
Author: William W. Busse
Author: Mario Castro
Author: Babro Dahlen
Author: Sven Erik Dahlen
Author: Leo M. Fabbri
Author: Marc Humbert
Author: Mina Gaga
Author: Guy F. Joos
Author: Bruce Levy
Author: Klaus F. Rabe
Author: Peter J. Sterk
Author: Susan J. Wilson
Author: Isabelle Vachier

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