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

Six questions about the asthma that stays uncontrolled on maximal inhaled therapy, and six answers that are all conditional: the document suggests, it does not recommend, and it says so in every one. Anti-IL-5 and anti-IL-5 receptor antibodies are suggested for severe uncontrolled eosinophilic asthma in adults, with a blood eosinophil count of at least 150 cells per microlitre as the threshold to start. Anti-IgE gets its own cut-offs for picking a responder: eosinophils of at least 260 cells per microlitre and a fraction of exhaled nitric oxide of at least 19.5 ppb. Anti-IL-4/13 is suggested both for severe eosinophilic asthma and for the corticosteroid-dependent patient, and there the eosinophil count no longer decides. Two older options survive alongside the biologics: inhaled tiotropium at GINA step 4 to 5, and a trial of chronic macrolide therapy in the patient who stays symptomatic, whatever their phenotype. The register's biologic trials are grouped below by the pathway each one blocks.

This guideline cites 4 of the 35 landmark trials in our Pulmonology register.

Source

Holguin F, Cardet JC, Chung KF, et al. Eur Respir J. 2020;55(1):1900588. · European Respiratory Journal

DOI

10.1183/13993003.00588-2019