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Management of severe asthma: A European Respiratory Society/American Thoracic Society guideline

Management of severe asthma: A European Respiratory Society/American Thoracic Society guideline
Management of severe asthma: A European Respiratory Society/American Thoracic Society guideline

This document provides clinical recommendations for the management of severe asthma. Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the European Respiratory Society/American Thoracic Society Task Force's questions. The evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of asthma experts, who made specific recommendations on six specific questions. After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made the following recommendations: 1) suggest using anti-interleukin (IL)-5 and anti-IL-5 receptor α for severe uncontrolled adult eosinophilic asthma phenotypes; 2) suggest using a blood eosinophil cut-point ≥150 μL−1 to guide anti-IL-5 initiation in adult patients with severe asthma; 3) suggest considering specific eosinophil (≥260 μL−1) and exhaled nitric oxide fraction (≥19.5 ppb) cut-offs to identify adolescents or adults with the greatest likelihood of response to anti-IgE therapy; 4) suggest using inhaled tiotropium for adolescents and adults with severe uncontrolled asthma despite Global Initiative for Asthma (GINA) step 4-5 or National Asthma Education and Prevention Program (NAEPP) step 5 therapies; 5) suggest a trial of chronic macrolide therapy to reduce asthma exacerbations in persistently symptomatic or uncontrolled patients on GINA step 5 or NAEPP step 5 therapies, irrespective of asthma phenotype; and 6) suggest using anti-IL-4/13 for adult patients with severe eosinophilic asthma and for those with severe corticosteroid-dependent asthma regardless of blood eosinophil levels. These recommendations should be reconsidered as new evidence becomes available.

0903-1936
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Holguin, Fernando, Cardet, Juan Carlos, Chung, Kian Fan, Diver, Sarah, Ferreira, Diogenes S., Fitzpatrick, Anne, Gaga, Mina, Kellermeyer, Liz, Khurana, Sandhya, Knight, Shandra, McDonald, Vanessa M., Morgan, Rebecca L., Ortega, Victor E., Rigau, David, Subbarao, Padmaja, Tonia, Thomy, Adcock, Ian M., Bleecker, Eugene R., Brightling, Chris, Boulet, Louis Philippe, Cabana, Michael, Castro, Mario, Chanez, Pascal, Custovic, Adnan, Djukanovic, Ratko, Frey, Urs, Frankemölle, Betty, Gibson, Peter, Hamerlijnck, Dominique, Jarjour, Nizar, Konno, Satoshi, Shen, Huahao, Vitary, Cathy and Bush, Andy (2020) Management of severe asthma: A European Respiratory Society/American Thoracic Society guideline. European Respiratory Journal, 55 (1), [1900588]. (doi:10.1183/13993003.00588-2019).

Record type: Article

Abstract

This document provides clinical recommendations for the management of severe asthma. Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the European Respiratory Society/American Thoracic Society Task Force's questions. The evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of asthma experts, who made specific recommendations on six specific questions. After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made the following recommendations: 1) suggest using anti-interleukin (IL)-5 and anti-IL-5 receptor α for severe uncontrolled adult eosinophilic asthma phenotypes; 2) suggest using a blood eosinophil cut-point ≥150 μL−1 to guide anti-IL-5 initiation in adult patients with severe asthma; 3) suggest considering specific eosinophil (≥260 μL−1) and exhaled nitric oxide fraction (≥19.5 ppb) cut-offs to identify adolescents or adults with the greatest likelihood of response to anti-IgE therapy; 4) suggest using inhaled tiotropium for adolescents and adults with severe uncontrolled asthma despite Global Initiative for Asthma (GINA) step 4-5 or National Asthma Education and Prevention Program (NAEPP) step 5 therapies; 5) suggest a trial of chronic macrolide therapy to reduce asthma exacerbations in persistently symptomatic or uncontrolled patients on GINA step 5 or NAEPP step 5 therapies, irrespective of asthma phenotype; and 6) suggest using anti-IL-4/13 for adult patients with severe eosinophilic asthma and for those with severe corticosteroid-dependent asthma regardless of blood eosinophil levels. These recommendations should be reconsidered as new evidence becomes available.

This record has no associated files available for download.

More information

Accepted/In Press date: 8 August 2019
e-pub ahead of print date: 2 January 2020

Identifiers

Local EPrints ID: 439773
URI: http://eprints.soton.ac.uk/id/eprint/439773
ISSN: 0903-1936
PURE UUID: a5ba0d9e-bbfd-4682-b7b0-01758cc8209f
ORCID for Ratko Djukanovic: ORCID iD orcid.org/0000-0001-6039-5612

Catalogue record

Date deposited: 01 May 2020 16:40
Last modified: 26 Nov 2021 02:33

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Contributors

Author: Fernando Holguin
Author: Juan Carlos Cardet
Author: Kian Fan Chung
Author: Sarah Diver
Author: Diogenes S. Ferreira
Author: Anne Fitzpatrick
Author: Mina Gaga
Author: Liz Kellermeyer
Author: Sandhya Khurana
Author: Shandra Knight
Author: Vanessa M. McDonald
Author: Rebecca L. Morgan
Author: Victor E. Ortega
Author: David Rigau
Author: Padmaja Subbarao
Author: Thomy Tonia
Author: Ian M. Adcock
Author: Eugene R. Bleecker
Author: Chris Brightling
Author: Louis Philippe Boulet
Author: Michael Cabana
Author: Mario Castro
Author: Pascal Chanez
Author: Adnan Custovic
Author: Urs Frey
Author: Betty Frankemölle
Author: Peter Gibson
Author: Dominique Hamerlijnck
Author: Nizar Jarjour
Author: Satoshi Konno
Author: Huahao Shen
Author: Cathy Vitary
Author: Andy Bush

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