Page 127 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 127
troversies and Dilemmas in Severe Asthma 6.1
Sanja Popović-Grle1,2,3
Abstract 1 University Hospital Centre
As severe asthma is a rather common respiratory disease, with a heavy burden for the patient, Zagreb, Croatia
the health system and society, it is important to recognize it and apply modern biological ther-
apy if indicated. As in today’s approach to asthma management, we tend no more to “me too 2 Clinic for Lung Diseases
medicine”, but to individual therapy in personalised and precise medicine. This article is deal- Jordanovac, Zagreb, Croatia
ing with some controversies and dilemmas in the field. After introducing biological therapy in
the early 2000s, systemic glucocorticoids became the second option for patients with severe 3 School of Medicine,
asthma. Starting with the controversy about accurate asthma diagnosis, then the question of University of Zagreb,
where patients with severe asthma are hiding, thirdly, are we treating those patients appro- Zagreb, Croatia
priately and comprehensively, and finally, are we emphasising enough the necessity of smok-
ing cessation? After reviewing the facts, and considering the extensive discussion exposed in
controversies, a similar analysis brought up a few dilemmas, i.e. how could we precisely de-
fine severe asthma phenotypes, how should we distinguish asthma from COPD in middle-aged
smoking patients, and how to make the right personalized choice of biologicals. There is also
the dilemma about age - how old (or young) should the patient be for the indication for biologi-
cals, and lastly, the length of treatment which is appropriate to assess a patient’s response to bi-
ologicals (“responder” or “non-responders”).
Keywords: asthma, diagnostics, precision medicine, smoking cessation, response to therapy as-
sessment
Introduction 2% of misdiagnosed patients were thought to
Asthma is the most frequent chronic respira- have asthma, but instead, they had other se-
tory disease1, with almost 1 in 8 children and rious diseases (like tracheal stenosis, and cor-
1 in 12 adults affected2. Asthma has a great onary artery disease...). A significant part of
impact on the person, the health system and these patients was frequently diagnosed with
society. Therefore, investigating asthma from asthma without sufficient evidence, which is
different angles is important, as is dealing not beneficial for the patient (over-diagnosis)-
with controversies and dilemmas in the field. around 33% of patients had innocent diseas-
es (i.e. rhinitis, GERB, anxiety etc.)3. Some of
The First Controversy in Asthma the patients also had a failure of recognising
Always Starts with Asthma Diagnosis asthma (underdiagnosis). In the general popu-
There is a substantial number of patients with lation of younger subjects < 44 years who on a
an incorrect diagnosis of asthma. Around questionnaire reported respiratory symptoms
https://doi.org/10.26 493/978 -961-293 -157-5.127-139
Sanja Popović-Grle1,2,3
Abstract 1 University Hospital Centre
As severe asthma is a rather common respiratory disease, with a heavy burden for the patient, Zagreb, Croatia
the health system and society, it is important to recognize it and apply modern biological ther-
apy if indicated. As in today’s approach to asthma management, we tend no more to “me too 2 Clinic for Lung Diseases
medicine”, but to individual therapy in personalised and precise medicine. This article is deal- Jordanovac, Zagreb, Croatia
ing with some controversies and dilemmas in the field. After introducing biological therapy in
the early 2000s, systemic glucocorticoids became the second option for patients with severe 3 School of Medicine,
asthma. Starting with the controversy about accurate asthma diagnosis, then the question of University of Zagreb,
where patients with severe asthma are hiding, thirdly, are we treating those patients appro- Zagreb, Croatia
priately and comprehensively, and finally, are we emphasising enough the necessity of smok-
ing cessation? After reviewing the facts, and considering the extensive discussion exposed in
controversies, a similar analysis brought up a few dilemmas, i.e. how could we precisely de-
fine severe asthma phenotypes, how should we distinguish asthma from COPD in middle-aged
smoking patients, and how to make the right personalized choice of biologicals. There is also
the dilemma about age - how old (or young) should the patient be for the indication for biologi-
cals, and lastly, the length of treatment which is appropriate to assess a patient’s response to bi-
ologicals (“responder” or “non-responders”).
Keywords: asthma, diagnostics, precision medicine, smoking cessation, response to therapy as-
sessment
Introduction 2% of misdiagnosed patients were thought to
Asthma is the most frequent chronic respira- have asthma, but instead, they had other se-
tory disease1, with almost 1 in 8 children and rious diseases (like tracheal stenosis, and cor-
1 in 12 adults affected2. Asthma has a great onary artery disease...). A significant part of
impact on the person, the health system and these patients was frequently diagnosed with
society. Therefore, investigating asthma from asthma without sufficient evidence, which is
different angles is important, as is dealing not beneficial for the patient (over-diagnosis)-
with controversies and dilemmas in the field. around 33% of patients had innocent diseas-
es (i.e. rhinitis, GERB, anxiety etc.)3. Some of
The First Controversy in Asthma the patients also had a failure of recognising
Always Starts with Asthma Diagnosis asthma (underdiagnosis). In the general popu-
There is a substantial number of patients with lation of younger subjects < 44 years who on a
an incorrect diagnosis of asthma. Around questionnaire reported respiratory symptoms
https://doi.org/10.26 493/978 -961-293 -157-5.127-139
