Guidelines for severe uncontrolled asthma

Arch Bronconeumol. 2015 May;51(5):235-46. doi: 10.1016/j.arbres.2014.12.007. Epub 2015 Feb 10.
[Article in English, Spanish]

Abstract

Since the publication, 9 years ago, of the latest SEPAR (Spanish Society of Pulmonology and Thoracic Surgery) Guidelines on Difficult-to-Control Asthma (DCA), much progress has been made in the understanding of asthmatic disease. These new data need to be reviewed, analyzed and incorporated into the guidelines according to their level of evidence and recommendation. Recently, consensus documents and clinical practice guidelines (CPG) addressing this issue have been published. In these guidelines, specific mention will be made of what the previous DCA guidelines defined as "true difficult-to-control asthma". This is asthma that remains uncontrolled after diagnosis and a systematic evaluation to rule out factors unrelated to the disease itself that lead to poor control ("false difficult-to-control asthma"), and despite an appropriate treatment strategy (Spanish Guidelines for the Management of Asthma [GEMA] steps 5 and 6): severe uncontrolled asthma. In this respect, the guidelines propose a revised definition, an attempt to classify the various manifestations of this type of asthma, a proposal for a stepwise diagnostic procedure, and phenotype-targeted treatment. A specific section has also been included on DCA in childhood, aimed at assisting healthcare professionals to improve the care of these patients.

Keywords: Asma grave; Asma no controlada; Asthma phenotype; Asthma treatment; Fenotipado del asma; Severe asthma; Tratamiento del asma; Uncontrolled asthma.

Publication types

  • Practice Guideline

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adrenergic beta-2 Receptor Agonists / therapeutic use
  • Adult
  • Anti-Asthmatic Agents / classification
  • Anti-Asthmatic Agents / therapeutic use
  • Asthma / classification
  • Asthma / diagnosis
  • Asthma / drug therapy*
  • Asthma / etiology
  • Bronchodilator Agents / therapeutic use
  • Child
  • Diagnosis, Differential
  • Drug Resistance
  • Drug Substitution
  • Drug Therapy, Combination
  • Environmental Exposure
  • Humans
  • Hypersensitivity, Immediate / complications
  • Hypersensitivity, Immediate / genetics
  • Severity of Illness Index
  • Vocal Cord Dysfunction / epidemiology

Substances

  • Adrenal Cortex Hormones
  • Adrenergic beta-2 Receptor Agonists
  • Anti-Asthmatic Agents
  • Bronchodilator Agents