A new study entitled “Severe Asthma: Definition, Diagnosis and Treatment” reviews areas of concern regarding severe asthma treatment that require particular attention by clinicians. The review was published in the journal Deutsches Ärzteblatt International.

Asthma incidence rose substantially during the 20^th century, with 1 in 11 children and 1 in 12 adults being affected with this disease. In the United States alone, the health costs related to asthma have increased to $56 billion per year, according to data from the CDC’s National Asthma Control Program (NACP). While treatment has proven effective for the majority of asthma patients, a minority of patients remains untreatable even with the most intensive available treatments. These patients have a condition termed as “severe asthma,” which still represents a challenge for diagnosis and healthcare resources.

In this review, the authors summarize and establish the definition of severe asthma, as well as the guidelines for its diagnosis and treatment, according to a wide literature survey and their own clinical experience. The authors highlight that severe asthma cases are identified when administration of therapeutics’ highest doses — including inhaled or oral corticosteroids — fail to reduce patients symptoms or if these return upon treatment decrease. The team points out that presented with this clinical scenario, it is crucial to understand the causes of these symptoms, since other diseases, allergies or patients’ failure to complete treatment may occur. In the cases when treatments applied do not result in patients improving, additional treatments must be considered, either by pulmonary rehabilitation or the introduction of other specific medications, such as iotropium, omalizumab or azithromycin for IgE-mediated asthma and non-eosinophilic asthma, respectively.

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The treatment of severe asthma is both time-consuming and requires specialized teams, according to the authors. As a result, since severe asthma is often not properly recognized. The authors suggest severe asthma patients should be assessed and followed in specialized asthma centers with physicians’ whose training covered both severe asthma diagnosis and treatment. Additionally, research on the prevalence of severe asthma should be increasingly implemented and the establishment of specialized asthma centers will allow patients to be included in clinical trials.