Severe and Difficult‐to‐Treat Asthma in Adults

@article{Israel2017SevereAD,
  title={Severe and Difficult‐to‐Treat Asthma in Adults},
  author={Elliot Israel and Helen K. Reddel},
  journal={The New England Journal of Medicine},
  year={2017},
  volume={377},
  pages={965–976}
}
Adults with severe asthma consume substantial human and financial resources. This review examines the biology, current diagnosis, and treatment of this multifaceted condition. 
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References

SHOWING 1-10 OF 55 REFERENCES
Three phenotypes of adult‐onset asthma
TLDR
To identify underlying mechanisms of adult‐onset asthma and to capture predictors of disease progression, detailed characterization and phenotyping is necessary.
The Asthma-COPD Overlap Syndrome.
TLDR
The asthma-COPD overlap syndrome is reviewed, showing an increasing awareness that many patients have features of both disorders.
Therapeutic interventions in severe asthma
TLDR
AIT, Allergen Immunotherapy, a prototype of Precision Medicine, is considered, also in light of the recent evidences of Sublingual Immunotherapy (SLIT) tablet efficacy and safety in mite allergic asthma patients.
Mepolizumab for Severe Eosinophilic Asthma (DREAM): A Multicentre, Double-Blind, Placebo-Controlled Trial
TLDR
To elucidate the efficacy, safety, and patient characteristics of responsiveness to mepolizumab (a humanized monoclonal antibody against interleukin 5), a large number of patients with severe, eosinophilic asthma were enrolled in 81 multinational centers.
The cost of treating severe refractory asthma in the UK: an economic analysis from the British Thoracic Society Difficult Asthma Registry
TLDR
This study uses data from the British Thoracic Society Difficult Asthma Registry to estimate direct healthcare treatment costs from an National Health Service perspective and examines factors that explain variations in costs.
Noneosinophilic asthma: a distinct clinical and pathologic phenotype.
Lung imaging in asthmatic patients: the picture is clearer.
Refractory asthma: mechanisms, targets, and therapy
TLDR
Investigation into the mechanisms behind glucocorticoid resistance will lead to novel treatments that improve control of severe refractory asthma and help patients with more severe disease who may be less responsive to steroids.
International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma
TLDR
Recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults and coordinated research efforts for improved phenotyping will provide safe and effective biomarker-driven approaches to severe asthma therapy are provided.
The immunology of asthma
TLDR
Results from in-depth molecular studies of mouse models in light of the results from the first clinical trials targeting key cytokines in humans are discussed and the extraordinary heterogeneity of asthma is described.
...
...