Fast Five Quiz: Severe Asthma Management

Praveen Buddiga, MD


July 07, 2021

In patients with severe asthma not controlled with GINA step 4-5 and National Asthma Education and Prevention Program (NAEPP) step 5 combination therapies, the addition of the long-acting muscarinic agent tiotropium has been shown to reduce as-needed use of SABAs, improve forced expiratory volume in 1 second (FEV1), and moderately reduce the risk for a severe exacerbation.

ERS/ATS guidelines conditionally recommend a trial of macrolide therapy in adult patients on GINA/NAEPP step 5 therapy who remain persistently symptomatic or uncontrolled to reduce asthma exacerbations.

According to the ERS/ATS guidelines, a blood eosinophil level of ≥ 260/μL and FeNO ≥ 20 ppb are important considerations that may help predict a good response to anti-IgE treatment in patients with severe asthma.

In randomized controlled trials, monoclonal antibodies that target IL-5 (eg, mepolizumab, reslizumab) or its receptor IL-5Rα (eg, benralizumab) have been shown to improve asthma-related outcomes. Anti-IL-5 and anti-IL-5Rα therapies reduce exacerbations and hospitalizations in patients with severe eosinophilic asthma. Mepolizumab and benralizumab are effective in reducing maintenance oral corticosteroid dose in patients with corticosteroid-dependent severe asthma. Another monoclonal antibody or biological agent, dupilumab, has also been shown to inhibit the biological effects of IL-4 and IL-13, thereby reducing chronic airway inflammation, tissue remodeling, and bronchial hyperresponsiveness.

For additional information, refer to the 2021 GINA Report, Global Strategy for Asthma Management and Prevention and the 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group.

Learn more about advances in the management of asthma.


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