Severe and Difficult‐to‐Treat Asthma in Adults

  title={Severe and Difficult‐to‐Treat Asthma in Adults},
  author={Elliot Israel and Helen K. Reddel},
  journal={The New England Journal of Medicine},
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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  • P. Bardin
  • Medicine
    The New England journal of medicine
  • 2018
Inhaled glucocorticoids are pivotal to achieve asthma control and disease stability in both children and adults; despite their use, with or without other treatments, many patients with asthma have ...
Variability of blood eosinophils in patients in a clinic for severe asthma
  • Ewa RakowskiSibo Zhao J. Reibman
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    Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology
  • 2019
Blood eosinophils are used to determine eligibility for agents targeting IL‐5 in patients with uncontrolled asthma. However, little is known about the variability of blood eosinophil measures in
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Effective treatment for severe asthma is a significant unmet need because many severe asthmatics exhibit corticosteroid‐unresponsive mixed granulocytic inflammation.
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The conditions discussed in this chapter will be allergic rhinitis, chronic rhinosinusitis with or without nasal polyps, aspirin-exacerbated respiratory disease, obstructive sleep apnea, gastroesophageal reflux disease/laryngopharyngealReflux disease, and vocal cord dysfunction.
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  • J. Muhrer
  • Medicine
    The Journal for Nurse Practitioners
  • 2018
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Dupixent (dupilumab) prescribing information is presented at ATS, San Diego, California, USA, May 17–22, 2019.
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  • W. Busse
  • Medicine, Biology
    Current opinion in allergy and clinical immunology
  • 2018
For patients with severe asthma and biomarkers indicating a type 2 inflammatory pathway, the addition of biologics has proven to be an effective approach to achieve disease control and is an appropriate next step treatment.
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Patients with obstructive lung disease have features of both asthma and chronic obstructive pulmonary disease and inhaled corticosteroids are key to the management of asthma, and they are recommended in patients with overlapping chronic obstructives pulmonary disease.
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Three phenotypes of adult‐onset asthma
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.
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Therapeutic interventions in severe asthma
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
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.
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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
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
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
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.