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Paediatric Pulmonology and Allergology
2007 October, Vol. X, No. 2 (3593-3607)
SEVERE ASTHMA IN ADULTS
Elisabeth H. Bel
Academic Medical Center of Amsterdam, Department of Respiratory Medicine F5-257, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, the NETHERLANDS
“Severe asthma” refers to asthma that remains difficult to control despite intensive multidrug therapy, extensive assessment and management of comorbidit, and long-term observation by an asthma specialist. The three main clinical phenotypes of severe asthma include asthma with frequent severe exacerbations, asthma with chronic airflow limitation, and steroid-resistant asthma. Many patients with severe asthma are oral-steroid dependent. Classical steroid-sparing drugs (gold, methotrexate, cyclosporin) are only weakly effective and have unacceptable side-effects. Monoclonal antibodies against immunoglobulin (Ig)E and tumour necrosis factor (TNF)-α have shown clinical benefit in subgroups of patients with severe asthma, and large studies are under way to confirm these promising findings (Breathe 2006; 3(2): 129–39, with permission).