Abstract
Severe difficult-to-control or uncontrolled asthma is defined as the impossibility of controlling symptoms and exacerbations despite using high-dose inhaled corticosteroids and a long-acting beta2-agonist in the previous year, or oral glucocorticoids for six months or more of the last year. The first step to take with these patients is to rule out other concomitant diseases, verify their compliance with the indicated treatment, and differentiate which phenotype they have (T2 allergic or eosinophilic asthma or non-T2 asthma) according to their clinical and blood test characteristics. Based on said phenotype, biologic treatment can be administered via anti-IgE (omalizumab), anti-IL-5 (mepolizumab, reslizumab, and benralizumab), or anti-IL-4/IL-13 (dupilumab) monoclonal antibodies in T2 asthma subtypes. To treat non-T2 type asthma, bronchial thermoplasty, systemic glucocorticoids, or even azithromycin can be considered.
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