The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Diagnosis of Severe Asthma: Definition and Identification

중증천식의 진단

  • Kim, Joo-Hee (Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine)
  • 김주희 (한림대학교 의과대학 한림대학교성심병원 호흡기-알레르기내과)
  • Published : 2018.04.01
⟨ Previous Next ⟩

Abstract

Severe asthma is associated with substantial morbidity, use of healthcare resources, and long-term sequelae including declining lung function and frequent exacerbations. The identification of severe asthma is challenging due to the heterogeneity of the disease, the complexity of diagnosis, and the impact of comorbidities. A structured approach to the assessment of severe asthma may be helpful to the practicing clinician. First, it is important to confirm a diagnosis of asthma. The lack of a response to treatment or the requirement for high doses of medication to control symptoms are signs of disease mimickers, comorbidities, or the influence of environmental factors. Second, medication adherence and the inhaler technique should be checked in advance. Third, the phenotypic characteristics of patients confirmed to have severe asthma can indicate the therapies likely to be most effective. Further research that seeks to define the phenotypes of severe asthma based on endotype will enable the development of novel and effective therapeutic options for patients with severe asthma.

Keywords

References

  1. Korean Academy of Asthma, Allergy, and Clinical Immunology, Korean Academy of Allergy and Respiratory Disease. Korean guideline for asthma [Internet]. Seoul (KR): Korean Academy of Asthma, Allergy, and Clinical Immunology, Korean Academy of Allergy and Respiratory Disease, c2018 [cited 2018 Mar 20]. Available from: http://www.allergy.or.kr/file/150527_01.pdf.
  2. Proceedings of the ATS workshop on refractory asthma: current understanding, recommendations, and unanswered questions. American Thoracic Society. Am J Respir Crit Care Med 2000;162:2341-2351. https://doi.org/10.1164/ajrccm.162.6.ats9-00
  3. Ivanova JI, Bergman R, Birnbaum HG, Colice GL, Silverman RA, McLaurin K. Effect of asthma exacerbations on health care costs among asthmatic patients with moderate and severe persistent asthma. J Allergy Clin Immunol 2012;129:1229-1235. https://doi.org/10.1016/j.jaci.2012.01.039
  4. Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014;43:343-373. https://doi.org/10.1183/09031936.00202013
  5. Bousquet J, Mantzouranis E, Cruz AA, et al. Uniform definition of asthma severity, control, and exacerbations: document presented for the World Health Organization Consultation on Severe Asthma. J Allergy Clin Immunol 2010;126:926-938. https://doi.org/10.1016/j.jaci.2010.07.019
  6. Robinson DS, Campbell DA, Durham SR, et al. Systematic assessment of difficult-to-treat asthma. Eur Respir J 2003;22:478-483. https://doi.org/10.1183/09031936.03.00017003
  7. Sulaiman I, Greene G, MacHale E, et al. A randomised clinical trial of feedback on inhaler adherence and technique in patients with severe uncontrolled asthma. Eur Respir J 2018;51:1701126. https://doi.org/10.1183/13993003.01126-2017
  8. Price D, Harrow B, Small M, Pike J, Higgins V. Establishing the relationship of inhaler satisfaction, treatment adherence, and patient outcomes: a prospective, real-world, cross-sectional survey of US adult asthma patients and physicians. World Allergy Organ J 2015;8:26. https://doi.org/10.1186/1939-4551-8-S1-A26
  9. Ledford DK, Lockey RF. Asthma and comorbidities. Curr Opin Allergy Clin Immunol 2013;13:78-86. https://doi.org/10.1097/ACI.0b013e32835c16b6
  10. Choi S, Hoffman EA, Wenzel SE, et al. Quantitative computed tomographic imaging-based clustering differentiates asthmatic subgroups with distinctive clinical phenotypes. J Allergy Clin Immunol 2017;140:690-700.e8. https://doi.org/10.1016/j.jaci.2016.11.053

Cited by

  1. Biological treatments for severe asthma vol.37, pp.4, 2018, https://doi.org/10.12701/yujm.2020.00647
  2. The nationwide retrospective cohort study by Health Insurance Review and Assessment Service proves that asthma management decreases the exacerbation risk of asthma vol.11, pp.1, 2018, https://doi.org/10.1038/s41598-021-81022-z