ZOR ASTIM
Astım havayolu inflamasyonu ile seyreden çeşitli klinik
SEVERE ASTHMA
Asthma is a common inflammatory disease that has wideclinical characteristics of the airway of the lungs. Asthmasymptoms can be prevented by avoiding triggers likeallergens and by the effective inhaled treatment. Themajority of asthma patients can be treated effectivelyby current medications. Difficult asthma is a distinctentity of asthma, comprising approximately %5-10 ofasthmatic patients. Despite the high effective treatment,the patients with asthma have disease that is poorlycontrolled. Severe asthmatics account for up to half ofthe cost for asthma. It will include asthma uncontrolledby new standard therapy, steroid dependent, steroidresistant asthma patients. Asthma related deathsare seen especially in severe asthma group. Asthmais a heterogeneous disease, consisting of differentphenotypes. It requires multidisciplinary approach fortreatment management. Severe asthma may suddenlydevelop in early time in disease or overtime. There was anevidence that severe asthma related to genetic factors,environmental factors, age, inflammation, duration ofdisease The genetic and environmental factors mayplay a role in severe asthma management. Phenotypetargetedtherapy has an important role in severe asthma,but it is associated with high treatment costs. At firstdiagnosis of asthma must be confirmed COPD and vocalcord dysfunction is needed to be particular interest indifferential diagnosis. Triggering factors such as smoking,atopy, work place condition and aspirin hypersensitivityshould be evaluated. Comorbidities that may affectasthma should be considered. This review examinesthe definition of asthma, its differential diagnosis,phenotypes and available treatment options.
___
- 1. Global Initiative for Asthma (GINA). Global strategy for
asthma management and prevention. Revised 2017 available
from http://www.ginasthma.org
- 2. Bavbek S, Misirligil Z; Study Group. A breath for health: an
exploratory study in severe asthma patients in Turkey. Allergy
2008;63(9): 1218-27.
- 3. Chung KF , Wenzel SE, Brozek JL, et al. International ERS/ATS
guidelines on definition, evaluation and treatment of severe
asthma. Eur Respir J 2014;43(2):343-73.
- 4. Bousquet J, Jeffery PK, Busse WW, et al. Asthma. From
bronchoconstriction to airways inflammation and remodeling.
Am J Respir Crit Care Med 2000;161:1720-45.
- 5. Miller AL, Lukacs NW. Chemokine receptors: understanding
their role in asthmatic disease. Immunol Allergy Clin North Am
2004;24:667-83, vii.
- 6. Simpson JL, Scott RJ, Boyle MJ, et al. Differential proteolytic
enzyme activity in eosinophillic and neutrophillic asthma. Am J
Respir Crit Care Med 2005;172:559-65.
- 7. Hastie AT, Moore WC, Meyers DA, et al. Analyses of asthma
severity phenotypes and inflammatory proteins in subjects
stratified by sputum granulocytes. J Allergy Clin Immunol 2010;
125: 1028–1036
- 8. Kharitonov SA. Exhaled nitric oxide and carbon monoxide in
asthma. Eur Respir Rev 1999;68:212-18.
- 9. Turktas H, Oguzulgen K, Kokturk N, et al. Correlation of
exhaled nitric oxide levels and airway inflammation markers in
stable asthmatic patients. J Asthma 2003;40:425-30.
- 10. Vignola AM, Mirabella F, Costanzo G, et al. Airway remodeling
in asthma. Chest 2003;123(3 Suppl):417S-22S
- 11. Robinson DS, Campbell DA, Durham SR, et al. Systematic
assessment of difficult-to-treat asthma. Eur Respir J 2003; 22:
478–483.
- 12. Aaron SD, Vandemheen KL, Boulet LP, et al. Overdiagnosis
of asthma in obese and nonobese adults. CMAJ 2008; 179:
1121–1131.
- 13. Moore WC, Bleecker ER, Curran-Everett D, et al.
Characterization of the severe asthma phenotype by the
National Heart, Lung, and Blood Institute’s Severe Asthma
Research Program. J Allergy Clin Immunol 2007; 119:405–413.
- 14. The ENFUMOSA cross-sectional Europe an multicentre study
of the clinical phenotype of chronic severe asthma. European
Network for Understanding Mechanisms of Severe Asthma. Eur
Respir J 2003;22(3):470-7.
- 15. Ten Brinke A, Grootendorst DC, Schmidt JT, et al. Chronic
sinusitis in severe asthma is related to sputum eosinophilia. J
Allergy Clin Immunol 2002; 109: 621–626.
- 16. Chaudhuri R, Livingston E, McMahon AD, et al. Effects of
smoking cessation on lung function and airway inflammation
in smokers with asthma. Am J Respir Crit Care Med 2006; 174:
127–133
- 17. Good JT Jr, Kolakowski CA, Groshong SD, et al. Refractory
asthma: importance of bronchoscopy to identify phenotypes
and direct therapy. Chest 2012; 141: 599–606.
- 18. Mastronarde JG, Anthonisen NR, Castro M, et al. Efficacy
of esomeprazole for treatment of poorly controlled asthma. N
Engl J Med 2009; 360: 1487–1499.
- 19. Holguin F, Bleecker ER, Busse WW, et al. Obesity and asthma:
an association modified by age of asthma onset. J Allergy Clin
Immunol 2011;127(6):148693
- 20. Peters-Golden M, Swern A, Bird SS, et al. Influence of body
mass index on the response to asthma controller agents. Eur
Respir J 2006; 27: 495–503
- 21. Vamos M, Kolbe J. Psychological factors in severe chronic
asthma. Aust NZ J Psychiatry 1999; 33: 538–544
- 22. Moore WC, Meyers DA, Wenzel SE, et al. Identification of
asthma phenotypes using cluster analysis in the Severe Asthma
Research Program. Am J Respir Crit Care Med 2010; 181: 315–
323.
163
- 23. Haldar P, Pavord ID, Shaw DE, et al. Cluster analysis and
clinical asthma phenotypes. Am J Respir Crit Care Med 2008;
178: 218–224.
- 24. Sutherland ER, Goleva E, Strand M, et al. Body mass and
glucocorticoid response in asthma. Am J Respir Crit Care Med
2008; 178: 682–687.
- 25. Berry M, Morgan A, Shaw DE, et al. Pathological features
and inhaled corticosteroid response of eosinophilic and noneosinophilic
asthma. Thorax 2007; 62: 1043–1049
- 26. Rabe KF, Atienza T, Magyar P, et al. Effect of budesonide in
combination with formoterol for reliever therapy in asthma
exacerbations: a randomised controlled, double-blind study.
Lancet 2006;368(9537):74453.
- 27. Scicchitano R, Aalbers R, Ukena D, et al. Efficacy and safety of
budesonide/formoterol single inhaler therapy versus a higher
dose of budesonide in moderate to severe asthma. Curr Med
Res Opin 2004;20(9):140318.
- 28. ten Brinke A, Zwinderman AH, Sterk PJ, et al. ‘‘Refractory’’
eosinophilic airway inflammation in severe asthma: effect of
parenteral corticosteroids. Am J Respir Crit Care Med 2004; 170:
601–605.
- 29. Ogirala RG, Aldrich TK, Prezant DJ, et al. High-dose
intramuscular triamcinolone in severe, chronic, life-threatening
asthma. N Engl J Med 1991; 324: 585–589
- 30. Ducharme FM, Lasserson TJ, Cates CJ. Longacting
beta2agonists versus antileukotrienes as add-on therapy to
inhaled corticosteroids for chronic asthma. Cochrane Database
Syst Rev 2006(4):CD003137.
- 31. Evans DJ, Taylor DA, Zetterstrom O, et al. A comparison
of lowdose inhaled budesonide plus theophylline and
highdose inhaled budesonide for moderate asthma. N Engl J
Med1997;337(20):14128
- 32. Spears M, Donnelly I, Jolly L, et al. Effect of lowdose
theophylline plus beclometasone on lung function in smokers
with asthma: a pilot study. Eur Respir J 2009;33(5):10107.
- 33. Barnes PJ. Theophylline. Am J Respir Crti Care Med
2013:188;9016
- 34. Kerstjens HA, Engel M, Dahl R, et al. Tiotropium in asthma
poorly controlled with standard combination therapy. N Engl J
Med 2012;367(13):1198207.
- 35. Bousquet J, Siergiejko Z, Swiebocka E, et al. Persistency
of response to omalizumab therapy in severe allergic (Ig-
Emediated) asthma. Allergy 2011;66(5):6718.
- 36. Bousquet J, Cabrera P, Berkman N, et al. The effect of
treatment with omalizumab, an anti-IgE antibody, on asthma
exacerbations and emergency medical visits in patients with
severe persistent asthma. Allergy 2005;60(3):3028.
- 37. Schumann C, Kropf C, Wibmer T, et al. Omalizumab in
patients with severe asthma: the XCLUSIVE study. Clin Respir J
2012;6(4):21527.
- 38. Reiter J, Demirel N, Mendy A, et al. Macrolides for the
longterm management of asthma a metaanalysis of randomized
clinical trials. Allergy 2013;68(8):10409.
- 39. Brusselle GG, Vanderstichele C, Jordens P, et al. Azithromycin
for prevention of exacerbations in severe asthma (AZISAST): a
multicentre randomised double-blind placebo-controlled trial.
Thorax 2013 Apr;68(4):3229.
- 40. Berry MA, Hargadon B, Shelley M, et al. Evidence of a role of
tumor necrosis factoralpha in refractory asthma. N Engl J Med
2006;354(7):697708.
- 41. Morjaria JB, Chauhan AJ, Babu KS, et al. The role of a soluble
TNFalpha receptor fusion protein (etanercept) in corticosteroid
refractory asthma: a double blind, randomised, placebo
controlled trial. Thorax 2008;63(7):58491.
- 42. Holgate ST, Noonan M, Chanez P, et al. Efficacy and safety
of etanercept in moderatetosevere asthma: a randomised,
controlled trial. Eur Respir J 2011;37(6):13529
- 43. Castro M , Rubin AS , Laviolette M, et al ; AIR2 Trial Study
Group. Effectiveness and safety of bronchial thermoplasty in
the treatment of severe asthma: a multicenter, randomized,
double-blind, sham-controlled clinical trial . Am J Respir Crit
Care Med . 2010 ; 181 ( 2 ): 116 - 124
- 44. Pavord ID, Korn S, Howarth P, et al. Mepolizumab for severe
eosinophilic asthma (DREAM): a multicentre, double-blind,
placebo-controlled trial. Lancet 2012;380(9842):651-9.
- 45. Corren J, Lemanske RF, Hanania NA, et al. Lebrikizumab
treatment in adults with asthma. N Engl J Med
2011;365(12):1088-98.
- 46. Rodrigo GJ, Castro-Rodríguez JA What is the role of
tiotropium in asthma?: a systematic review with meta-analysis.
Chest. 2015 Feb;147(2):388-39
- 47. Castro, M, Zangrilli, J, Wechsler, ME. Reslizumab for
inadequately controlled asthma with elevated blood eosinophil
counts: results from two multicentre, parallel, double-blind,
randomised, placebo-controlled, phase 3 trials. Lancet Respir
Med 2015; 3: 355–366