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What is Severe Asthma?
Prevalence of Severe Asthma
- GINA step 4-5 treatment (cumulative total 23.5 % of all asthma patients).
- Difficult to treat asthma = poor asthma control + GINA step 4-5 treatment (cumulative total 17.4 % of all asthma patients).
- Severe asthma = poor asthma control + GINA step 4-5 treatment + good adherence and inhaler technique (3.7 % of all asthma patients) 3.
The Severe Asthma Services
Purpose of Severe Asthma Service
Assessment and Diagnosis
Full pulmonary function tests (PFT)
- Bronchodilator reversibility (BDR)
- Lung function tests
Immunoglobulin E (IgE)
Exhaled nitric oxide (FeNO) to quantify airway inflammation
3. Other necessary blood tests if indicated
- Allergy tests to identify atopy and allergic triggers or diseases (eg. Allergic bronchopulmonary aspergillosis)
- Autoantibodies to look for connective tissue disease (eg. Esinophilic granulomatosis with polyangiitis)
- Immunoglobulin test for immune function screen
4. Image tests
- X-Ray test
- High resolution computed tomography (HRCT) thorax and sinus
Treatment of Relevant Comorbidities
- Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. 2020. https://ginasthma.org/wp-content/uploads/2020/04/GINA-2020-full-report_-final-_wms.pdf. Date last accessed: 06 April 2020.
- Chung, K.F., et al., International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. European Respiratory Journal, 2014. 43(2): p. 343-373.
- Hekking, P.-P.W., et al., The prevalence of severe refractory asthma. 2015. 135(4): p. 896-902.
- Radhakrishna, N., et al., Profile of difficult to treat asthma patients referred for systematic assessment. 2016. 117: p. 166-173.
- 2019 GINA pocket guide: Diagnosis and Management of Difficult-to-treat and Severe Asthma in adolescent and adult patients V2.0 April 2019. https://ginasthma.org/wp-content/uploads/2019/04/GINA-Severe-asthma-Pocket-Guide-v2.0-wms-1.pdf. Date last accessed: 06 April 2020.
- Holguin, F., et al.,
Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline. European Respiratory Journal, 2020. 55(1): p. 1900588.
Late Updated: Aug 2020
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