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Clinical Issues™

Clinical Issues in Severe Asthma

Debates and Discussions About Personalizing Patient Management

Meeting Slides

Clinical Practice Guidelines

Global Strategy for Asthma Management and Prevention

Global Initiative for Asthma (GINA) 2018.

International ERS/ATS Guidelines on Definition, Evaluation and Treatment of Severe Asthma

Chung KF, et al. Eur Respir J. 2014;43(2):343-373.

An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FeNO) for clinical applications.

Dweik RA, et al. Am J Respir Crit Care Med. 2011;184(5):602-615.

Patient Resources

Asthma and Allergy Foundation of America (AAFA)

AAFA is dedicated to improving the quality of life for people with asthma and allergic diseases through education, advocacy, and research.

American College of Allergy, Asthma Immunology (ACAAI)

The ACAAI fosters a culture of collaboration and congeniality in which members work toward the common goals of patient care, education, advocacy, and research.

American Lung Association

The American Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease through education, advocacy, and research.

American Thoracic Society (ATS)

The mission of the ATS is to improve health worldwide by advancing research, clinical care, and public health in respiratory disease, critical illness, and sleep disorders.

Asthma Action Plan

This printable reference tool is designed to help patients know when to use their different asthma medications and when to call their health care providers.

Clinical Assessment Tools

Asthma Control Test (ACT)

This 5-question test evaluates asthma control over the past 4 weeks on a 5-point Likert scale. A score of <20 on the ACT suggests asthma that is uncontrolled. Nathan RA, et al. J Allergy Clin Immunol. 2004;113(1):59-65.

Asthma Control Questionnaire (ACQ)

This 7-question assessment tool measures asthma control over the past 7 days. Six questions are self-administered by the patient, and 1 question requires a clinician’s input. Scores range from 1 (totally controlled) to 6 (severely uncontrolled). Juniper EF, et al. Eur Respir J. 1999;14(4):902-907.

Asthma Therapy Assessment Questionnaire (ATAQ)

This 4-question test assesses asthma control over the past 4 weeks. Each question has a possible score of 0 or 1; if the sum of the 4 question scores is >1, the patient’s asthma may be uncontrolled. Vollmer WM, et al. Am J Respir Crit Care Med. 1999;160(5 Pt 1):1647-1652.

Suggested Readings

American Thoracic Society International Conference Asthma Posters and Oral Sessions. May 18-23, 2018. San Diego, California.

Care pathways for the selection of a biologic in severe asthma.

Bousquet J, et al. Eur Respir J. 2017;50(6):1701782.

Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial.

Bleecker ER, et al. Lancet. 2016;388(10056):2115-2127.

Liberty Asthma QUEST: phase 3 randomized, double-blind, placebo-controlled, parallel-group study to evaluate dupilumab efficacy/safety in patients with uncontrolled, moderate-to-severe asthma.

Busse WW, et al. Adv Ther. May 2018 [Epub Ahead of Print].

A randomized, controlled phase 3 study, LIBERTY ASTHMA QUEST, evaluating the efficacy and safety of dupilumab in uncontrolled moderate-to-severe asthma.

Castro M, et al. American Thoracic Society International Conference. May 18-23, 2018. San Diego, California. Presentation Session A101. Presentation A7700.

Reslizumab for inadequately controlled asthma with elevated blood eosinophil counts: results from two multicentre, parallel, double-blind, randomised, placebo-controlled, phase 3 trials.

Castro M, et al. Lancet Respir Med. 2015;3(5):355-366.

Dupilumab efficacy and safety in moderate-to-severe uncontrolled asthma.

Castro M, et al. N Engl J Med. May 2018. [Epub ahead of print].

Tezepelumab in adults with uncontrolled asthma.

Corren J, et al. N Engl J Med. 2017;377(10):936-946.

A review of anti-IgE monoclonal antibody (omalizumab) as add on therapy for severe allergic (IgE-mediated) asthma.

D’Amato G, et al. Ther Clin Risk Manag. 2007;3(4):613-619.

Inflammatory and comorbid features of patients with severe asthma and frequent exacerbations.

Denlinger LC, et al. Am J Respir Crit Care Med. 2017;195(3):302-313.

Fevipiprant, a prostaglandin D2 receptor 2 antagonist, in patients with persistent eosinophilic asthma: a single-centre, randomised, double-blind, parallel-group, placebo-controlled trial.

Gonem S, et al. Lancet Respir Med. 2016;4(9):699-707.

Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial.

FitzGerald JM, et al. Lancet. 2016;388(10056):2128-2141.

Severe and difficult-to-treat asthma in adults.

Israel E, Reddel HK. N Engl J Med. 2017;377(10):965-976.

Adult asthma biomarkers.

Kim MA, et al. Curr Opin Allergy Clin Immunol. 2014;14(1):49-54.

Mepolizumab treatment in patients with severe eosinophilic asthma.

Ortega HG, et al. N Engl J Med. 2014;371(13):1198-1207.

Severe eosinophilic asthma treated with mepolizumab stratified by baseline eosinophil thresholds: a secondary analysis of the DREAM and MENSA studies.

Ortega HG, et al. Lancet Respir Med. 2016;4(7):549-556

Allergen immunotherapy in asthma; what is new?

Passalacqua G, et al. Asthma Res Pract. 2015;1:6.

Co-morbidities in severe asthma: clinical impact and management.

Porsbjerg C, Menzies-Gow, A. Respirology. 2017;22(4):651-661.

Efficacy and safety of dupilumab in glucocorticoid-dependent severe asthma.

Rabe KF, et al. N Engl J Med. May 2018. [Epub ahead of print].

Dupilumab efficacy and safety in adults with uncontrolled persistent asthma despite use of medium-to-high-dose inhaled corticosteroids plus a long-acting β2 agonist: a randomised double-blind placebo-controlled pivotal phase 2b dose-ranging trial.

Wenzel S, et al. Lancet. 2016;388(10039):31-44

Interactive Presentation

Patient Interview

With Amanda


Patient Interview

With Matthew


Relevant Resources

Chronic Obstructive Pulmonary Disease, Asthma, or Both

Differential Diagnosis and Comprehensive Management Strategies

Improving Outcomes in Chronic Obstructive Pulmonary Disease

Optimizing Maintenance Therapy Across Healthcare Settings

Clearing the Air

Improving Outcomes for Patients with COPD

Comprehensive Management of Chronic Obstructive Pulmonary Disease

Collaborative Approaches to Guideline-Concordant Patient Care

Clinical Updates in the Management of Severe Asthma

New Strategies for Individualizing Long-term Care

Improving Outcomes in Severe Asthma

A New Era in Precision Medicine

Caring for Patients with Severe Asthma

Evolving Best Practices to Optimize Outcomes

Clinical Issues in Severe Asthma

Consensus and Controversies on the Road to Precision Medicine

Breathing Life Into COPD Management

Ongoing Monitoring, Pulmonary Rehabilitation, and Individualized Care