Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline
| Autor: | Vanessa M. McDonald, Huahao Shen, Kian Fan Chung, Diogenes S. Ferreira, Dominique Hamerlijnck, Nizar N. Jarjour, Anne M. Fitzpatrick, Rebecca L. Morgan, Mina Gaga, Thomy Tonia, Andrew Bush, Sandhya Khurana, Fernando Holguin, Ian M. Adcock, Ratko Djukanovic, Pascal Chanez, David Rigau, Liz Kellermeyer, Padmaja Subbarao, Eugene R. Bleecker, Louis-Philippe Boulet, Juan Carlos Cardet, Mario Castro, Satoshi Konno, Adnan Custovic, Christopher E. Brightling, Sarah Diver, Victor E. Ortega, Urs Frey, Betty Frankemölle, Cathy Vitary, Michael D. Cabana, Peter G. Gibson, Shandra L Knight |
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| Přispěvatelé: | Commission of the European Communities |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Pulmonary and Respiratory Medicine medicine.medical_specialty Adolescent Severe asthma Respiratory System MEDLINE Psychological intervention Nitric Oxide 03 medical and health sciences 0302 clinical medicine Adrenal Cortex Hormones medicine Humans 030212 general & internal medicine Respiratory system 610 Medicine & health Intensive care medicine 11 Medical and Health Sciences Asthma business.industry Guideline Eosinophil medicine.disease United States respiratory tract diseases Uncontrolled asthma Eosinophils medicine.anatomical_structure 030228 respiratory system Exhalation Exhaled nitric oxide business 360 Social problems & social services |
| Zdroj: | EUROPEAN RESPIRATORY JOURNAL r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname |
| ISSN: | 2541-9617 0869-0189 0903-1936 |
| Popis: | This document provides clinical recommendations for the management of severe asthma. Comprehensive evidence syntheses, including metaanalyses, 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:• suggest using anti-interleukin (IL)-5 and anti-IL-5 receptor α for severe uncontrolled adult eosinophilic asthma phenotypes;• suggest using a blood eosinophil cut-point ≥150 μL−1 to guide anti-IL-5 initiation in adult patients with severe asthma;• 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;• 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;• 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;• 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. |
| Databáze: | OpenAIRE |
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