Δημοσιεύθηκαν πρόσφατα οι νεότερες διεθνείς κατευθυντήριες οδηγίες της Ευρωπαϊκής και Αμερικάνικης εταιρείας νοσημάτων θώρακος (European Respiratory Society and American Thoracic Society) για το σοβαρό βρογχικό άσθμα:
Chung KF, et al.
International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma.
Eur Respir J. 2014 Feb;43(2):343-73.
Severe or therapy-resistant asthma is increasingly recognised as a major unmet need. A Task Force, supported by the European Respiratory Society and American Thoracic Society, reviewed the definition and provided recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults. A literature review was performed, followed by discussion by an expert committee according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach for development of specific clinical recommendations. When the diagnosis of asthma is confirmed and comorbidities addressed, severe asthma is defined as asthma that requires treatment with high dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming “uncontrolled” or that remains “uncontrolled” despite this therapy. Severe asthma is a heterogeneous condition consisting of phenotypes such as eosinophilic asthma. Specific recommendations on the use of sputum eosinophil count and exhaled nitric oxide to guide therapy, as well as treatment with anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty are provided. Coordinated research efforts for improved phenotyping will provide safe and effective biomarker-driven approaches to severe asthma therapy.
H πρόσβαση στην οδηγία είναι ελεύθερη από την ιστοσελίδα της Αμερικάνικης Εταιρείας Νοσημάτων Θώρακος (ATS) στην ενότητα «Allergy & Asthma»:
Official European Respiratory Society / American Thoracic Society Clinical Practice Guidelines on the Definition, Evaluation, and Treatment of Severe Asthma (2014):
Εκδοτικό σχόλιο από το EuropeanRespiratoryJournal (η πρόσβαση είναι ελεύθερη):
Brusselle GG, Kraft M.
Trustworthy guidelines on severe asthma thanks to the ERS and ATS.
Eur Respir J. 2014 Feb;43(2):315-8.
«Τhe greatest unmet need in asthma care is in the severe asthma arena, where heterogeneity with regard to clinical presentation and course has posed therapeutic challenges. The identification of clinical and molecular phenotypes, as discussed in this version of the severe asthma guidelines, moves the field forward and will ultimately lead us to more personalised therapy.
These guidelines describe the definition of severe asthma and provide recommendations for an approach to diagnostics and therapeutics given the data available today.»
Να υπενθυμίσουμε πως και η Ευρωπαϊκή Ακαδημία Αλλεργιολογίας και Κλινικής Ανοσολογίας (EAACI) δημοσίευσε αντίστοιχες οδηγίες τον Δεκέμβριο του 2013 με εστίαση στην σχέση των υποτροπιαζόντων παροξυσμών του βρογχικού άσθματος με το σοβαρό άσθμα :
CustovicA, JohnstonSL, PavordI, GagaM, FabbriL, BelEH, LeSouëfP, LötvallJ, DemolyP, AkdisCA, RyanD, Mäkelä MJ, MartinezF, HollowayJW, SaglaniS, O‘ByrneP, PapiA, SergejevaS, MagnanA, DelGiaccoS, KalayciO, HamelmannE, PapadopoulosNG.
EAACI position statement on asthma exacerbations and severe asthma.
Allergy. 2013 Dec;68(12):1520-31.
Asthma exacerbations and severe asthma are linked with high morbidity, significant mortality and high treatment costs. Recurrent asthma exacerbations cause a decline in lung function and, in childhood, are linked to development of persistent asthma. This position paper, from the European Academy of Allergy and Clinical Immunology, highlights the shortcomings of current treatment guidelines for patients suffering from frequent asthma exacerbations and those with difficult-to-treat asthma and severe treatment-resistant asthma. It reviews current evidence that supports a call for increased awareness of
(i) the seriousness of asthma exacerbations and
(ii) the need for novel treatment strategies in specific forms of severe treatment-resistant asthma.
There is strong evidence linking asthma exacerbations with viral airway infection and underlying deficiencies in innate immunity and evidence of a synergism between viral infection and allergic mechanisms in increasing risk of exacerbations.
Nonadherence to prescribed medication has been identified as a common clinical problem amongst adults and children with difficult-to-control asthma.
Appropriate diagnosis, assessment of adherence and other potentially modifiable factors (such as passive or active smoking, ongoing allergen exposure, psychosocial factors) have to be a priority in clinical assessment of all patients with difficult-to-control asthma.
Further studies with improved designs and new diagnostic tools are needed to properly characterize
(i) the pathophysiology and risk of asthma exacerbations, and
(ii) the clinical and pathophysiological heterogeneity of severe asthma.
(Προαπαιτείται εγγραφή για την πρόσβαση στο πλήρες κείμενο της τοποθέτησης):