Abstract
ABSTRACTAlthough a minority of asthma patients suffer from severe asthma, they represent a major clinical challenge in terms of poor symptom control despite high-dose treatment, risk of exacerbations, and side effects. Novel biological treatments may benefit patients with severe asthma, but are expensive, and are only effective in appropriately targeted patients. In some patients, symptoms are driven by other factors than asthma, and all patients with suspected severe asthma (‘difficult asthma’) should undergo systematic assessment, in order to differentiate between true severe asthma, and ‘difficult-to-treat’ patients, in whom poor control is related to factors such as poor adherence or co-morbidities. The Nordic Consensus Statement on severe asthma was developed by the Nordic Severe Asthma Network, consisting of members from Norway, Sweden, Finland, Denmark, Iceland and Estonia, including representatives from the respective national respiratory scientific societies with the aim to provide an overview and recommendations regarding the diagnosis, systematic assessment and management of severe asthma. Furthermore, the Consensus Statement proposes recommendations for the organization of severe asthma management in primary, secondary, and tertiary care.
Highlights
The majority of asthma patients have mild to moderate disease, a proportion of asthma patients have difficulty in achieving control on standard treatment or require very high doses of treatment to maintain asthma control, and risk of side effects [1,2]: In the patients with severe asthma, control is not obtained despite correction of comorbidities and correct use of high doses of asthma medications
There are a number of potential causes of poor symptom control in asthma [4], and systematic assessment is important when differentiating between patients with severe asthma, and patients with other causes of poor asthma control, such as lack of adherence or co-morbidities, termed ‘difficult-to-treat’ asthma
A number of novel treatments for severe asthma are under development, some of which have been approved for clinical use: treatment with anti-IgE and anti-IL5 monoclonal antibodies are effective in reducing the risk of asthma exacerbations [5,6]
Summary
The majority of asthma patients have mild to moderate disease, a proportion of asthma patients have difficulty in achieving control on standard treatment or require very high doses of treatment to maintain asthma control, and risk of side effects [1,2]: In the patients with severe asthma, control is not obtained despite correction of comorbidities and correct use of high doses of asthma medications. Systematic assessment and phenotyping of patients with possible severe asthma requires a highly specialized setting, to ensure an appropriate and effective diagnostic work-up [8]. [Systematic assessment of patients with severe asthma has been proven effective in reducing the number of exacerbations, as well as overall health care utilization 2,11].
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