Phenotype-Guided Asthma Therapy: An Alternative Approach to Guidelines
| Autor: | Luis Pérez de Llano, Nagore Blanco Cid, Irene Martin Robles, David Dacal Rivas |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
lcsh:Immunologic diseases. Allergy
Pulmonary and Respiratory Medicine medicine.medical_specialty Pharmacological therapy asthma treatment Moderate asthma Asthma treatment Review 03 medical and health sciences 0302 clinical medicine medicine asthma endotype Immunology and Allergy 0601 history and archaeology Intensive care medicine Asthma Asthma therapy 060102 archaeology business.industry 06 humanities and the arts Guideline personalized medicine asthma medicine.disease asthma phenotype 030228 respiratory system Formoterol Personalized medicine lcsh:RC581-607 business medicine.drug |
| Zdroj: | Journal of Asthma and Allergy Journal of Asthma and Allergy, Vol Volume 14, Pp 207-217 (2021) |
| ISSN: | 1178-6965 |
| Popis: | Luis Pérez de Llano, David Dacal Rivas, Nagore Blanco Cid, Irene Martin Robles Head of the Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo. C/ Doctor Ulises Romero, nº 1, Lugo, 27003, SpainCorrespondence: Luis Pérez de LlanoHead of the Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, C/Doctor Ulises Romero, nº 1, Lugo, 27003, SpainTel +34 982296000Email eremos262@hotmail.comAbstract: Despite recent advances in therapy, a substantial proportion of asthmatics remain not well controlled. The classical stepwise approach to pharmacological therapy in adult asthma recommends that treatment is progressively stepped up by increasing the inhaled corticosteroid (ICS) dose or by adding another controller medication- to achieve symptom control and reduce the risk of exacerbations, and stepped down after a period of control. In general, asthma guideline recommendations do not reflect that there are significant differences between ICS in terms of potency. Moreover, they do not consider efficacy and safety separately, incorrectly assuming that “low” and “high” dose categories inevitably correspond with low and high risk of systemic effects. Another point of criticism is the fact that guidelines do not take into account the inflammatory profile of the patient, although substantial groups of patients with mild and moderate asthma have little evidence of “T2-high” inflammation, and by extension are likely to show a poor response to ICS treatment. On the other hand, the latest version of the Global Initiative for Asthma (GINA) equally recommends regular ICS and ICS/formoterol as needed to prevent exacerbations in step 2 patients, without taking into consideration that the therapeutic objectives (exacerbations, symptoms) may differ between individual patients and that different goals may warrant distinct treatment strategies. In this review, we bring to the table several controversial issues concerning asthma treatment and suggest an alternative proposal that takes into consideration the potential side effects of high ICS doses, the patient’s inflammatory profile and the therapeutic goals to be achieved.Keywords: asthma, asthma treatment, asthma phenotype, asthma endotype, personalized medicine |
| Databáze: | OpenAIRE |
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