Περίληψη:
Asthma exacerbations and severe asthma are linked with high morbidity, significant mortality and high treatment costs. Recurrent asthma exacerbations cause a decline in lung function and, in childhood, are linked to development of persistent asthma. This position paper, from the European Academy of Allergy and Clinical Immunology, highlights the shortcomings of current treatment guidelines for patients suffering from frequent asthma exacerbations and those with difficult-to-treat asthma and severe treatment-resistant asthma. It reviews current evidence that supports a call for increased awareness of (i) the seriousness of asthma exacerbations and (ii) the need for novel treatment strategies in specific forms of severe treatment-resistant asthma. There is strong evidence linking asthma exacerbations with viral airway infection and underlying deficiencies in innate immunity and evidence of a synergism between viral infection and allergic mechanisms in increasing risk of exacerbations. Nonadherence to prescribed medication has been identified as a common clinical problem amongst adults and children with difficult-to-control asthma. Appropriate diagnosis, assessment of adherence and other potentially modifiable factors (such as passive or active smoking, ongoing allergen exposure, psychosocial factors) have to be a priority in clinical assessment of all patients with difficult-to-control asthma. Further studies with improved designs and new diagnostic tools are needed to properly characterize (i) the pathophysiology and risk of asthma exacerbations, and (ii) the clinical and pathophysiological heterogeneity of severe asthma. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Συγγραφείς:
Custovic, A.
Johnston, S.L.
Pavord, I.
Gaga, M.
Fabbri, L.
Bel, E.H.
Le Souëf, P.
Lötvall, J.
Demoly, P.
Akdis, C.A.
Ryan, D.
Mäkelä, M.J.
Martinez, F.
Holloway, J.W.
Saglani, S.
O'Byrne, P.
Papi, A.
Sergejeva, S.
Magnan, A.
Del Giacco, S.
Kalayci, O.
Hamelmann, E.
Papadopoulos, N.G.
Λέξεις-κλειδιά:
corticosteroid; immunoglobulin E; interleukin 12; interleukin 5; monoclonal antibody; tiotropium bromide, adaptive immunity; adulthood; airway remodeling; asthma; asthma exacerbation; atopy; childhood; chronic obstructive lung disease; disease exacerbation; drug dose increase; Enterovirus infection; eosinophil count; forced expiratory volume; high risk patient; host resistance; human; infection risk; innate immunity; lung function; multicenter study (topic); pneumococcal infection; practice guideline; primary medical care; priority journal; respiratory tract inflammation; review; Rhinovirus infection; severe asthma; skin test; sputum analysis; treatment response; urticaria; viral respiratory tract infection; virus load; wheezing, adult asthma; asthma exacerbations; childhood asthma; disease heterogeneity; severe asthma, Animals; Asthma; Disease Progression; Humans; Practice Guidelines as Topic; Severity of Illness Index
