Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline
Por:
Holguin, F, Cardet, JC, Chung, KF, Diver, S, Ferreira, DS, Fitzpatrick, A, Gaga, M, Kellermeyer, L, Khurana, S, Knight, S, McDonald, VM, Morgan, RL, Ortega, VE, Rigau, D, Subbarao, P, Tonia, T, Adcock, IM, Bleecker, ER, Brightling, C, Boulet, LP, Cabana, M, Castro, M, Chanez, P, Custovic, A, Djukanovic, R, Frey, U, Frankemolle, B, Gibson, P, Hamerlijnck, D, Jarjour, N, Konno, S, Shen, HH, Vitary, C, Bush, A
Publicada:
1 ene 2020
Resumen:
This document provides clinical recommendations for the management of severe asthma. Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the European Respiratory Society/American Thoracic Society Task Force's questions. The evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of asthma experts, who made specific recommendations on six specific questions. After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made the following recommendations: 1) suggest using anti-interleukin (IL)-5 and anti-IL5 receptor a for severe uncontrolled adult eosinophilic asthma phenotypes; 2) suggest using a blood eosinophil cut-point >= 150 mu L-1 to guide anti-IL-5 initiation in adult patients with severe asthma; 3) suggest considering specific eosinophil (>= 260 mu L-1) and exhaled nitric oxide fraction (>= 19.5 ppb) cut-offs to identify adolescents or adults with the greatest likelihood of response to anti-IgE therapy; 4) suggest using inhaled tiotropium for adolescents and adults with severe uncontrolled asthma despite Global Initiative for Asthma (GINA) step 4-5 or National Asthma Education and Prevention Program (NAEPP) step 5 therapies; 5) suggest a trial of chronic macrolide therapy to reduce asthma exacerbations in persistently symptomatic or uncontrolled patients on GINA step 5 or NAEPP step 5 therapies, irrespective of asthma phenotype; and 6) suggest using anti-IL-4/13 for adult patients with severe eosinophilic asthma and for those with severe corticosteroid-dependent asthma regardless of blood eosinophil levels. These recommendations should be reconsidered as new evidence becomes available.
Filiaciones:
Holguin, F:
Univ Colorado, Pulm Sci & Crit Care Med, Denver, CO 80202 USA
Cardet, JC:
Univ S Florida, Allergy & Immunol, Tampa, FL 33620 USA
Chung, KF:
Imperial Coll London, Natl Heart & Lung Inst, Expt Studies Med, London, England
Diver, S:
Univ Leicester, Resp Biomed Unit, Leicester, Leics, England
Ferreira, DS:
Univ Fed Parana, Complexo Hosp Clin, Alergia & Imunol, Curitiba, Parana, Brazil
Monash Univ, Sch Publ Hlth & Prevent Med, Melbourne, Vic, Australia
Fitzpatrick, A:
Emory Univ, Div Pulmonol Allergy Immunol, Cyst Fibrosis & Sleep, Atlanta, GA 30322 USA
Gaga, M:
Athens Chest Hosp, Resp Med Dept, Athens, Greece
Athens Chest Hosp, Asthma Ctr, Athens, Greece
Kellermeyer, L:
Natl Jewish Hlth, Biomed Lib, Denver, CO USA
Khurana, S:
Univ Rochester, Pulm Dis & Crit Care, Rochester, NY USA
Knight, S:
Natl Jewish Hlth, Biomed Lib, Denver, CO USA
McDonald, VM:
Univ Newcastle, Sch Nursing, Newcastle, NSW, Australia
Morgan, RL:
McMaster Univ, Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
Ortega, VE:
Wake Forest Sch Med, Pulm Crit Care Allergy & Immunol Dis, Winston Salem, NC 27101 USA
Rigau, D:
Iberoamer Cochrane Ctr, Barcelona, Spain
Subbarao, P:
SickKids, Dept Pediat, Toronto, ON, Canada
Tonia, T:
Univ Bern, Inst Social & Prevent Med, Bern, Switzerland
Adcock, IM:
Imperial Coll London, Natl Heart & Lung Inst, Mol Cell Biol Grp, London, England
Bleecker, ER:
Univ Arizona, Div Genet Genom & Precis Med, Tucson, AZ USA
Brightling, C:
Univ Leicester, Dept Resp Sci, Leicester, Leics, England
Boulet, LP:
Laval Univ, Resp Med, Quebec City, PQ, Canada
Cabana, M:
Univ Calif San Francisco, Div Gen Pediat, San Francisco, CA 94143 USA
Castro, M:
Washington Univ, Div Pulm & Crit Care Med, St Louis, MO 63110 USA
Chanez, P:
Univ Aix Marseille, Dept Resp Dis, Marseille, France
Custovic, A:
Imperial Coll London, Natl Heart & Lung Inst, Paediat Allergy, London, England
Djukanovic, R:
Univ Southampton, Resp Biomed Res, Southampton, Hants, England
Frey, U:
Univ Childrens Hosp, Dept Pediat, Basel, Switzerland
Frankemolle, B:
European Lung Fdn, Lausanne, Switzerland
Gibson, P:
Univ Newcastle, Sch Med & Publ Hlth, Newcastle, NSW, Australia
Hamerlijnck, D:
European Lung Fdn, Lausanne, Switzerland
Jarjour, N:
Univ Wisconsin, Div Pulm & Crit Care, Madison, WI USA
Konno, S:
Hokkaido Univ, Fac Med, Dept Resp Med, Sapporo, Hokkaido, Japan
Hokkaido Univ, Grad Sch Med, Sapporo, Hokkaido, Japan
Shen, HH:
Zhejiang Univ, Dept Resp & Crit Care Med, Affiliated Hosp 2, Sch Med, Hangzhou, Peoples R China
Vitary, C:
Univ Pittsburgh, Asthma Inst, Pittsburgh, PA USA
Bush, A:
Imperial Coll London, Natl Heart & Lung Inst, Dept Paediat, London, England
Green Published, Bronze
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