Page 129 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 129
en put on a short course of OCS, without there should be at least 5% of severe asthmat- 129
an individualised strategy for the patient dur- ics, which is 10,792 patients. Not all of them
ing the high-risk period after an emergency are candidates for biological therapy; eligible controversies and dilemmas in severe asthma
room or hospital visit. Around 29% of asth- are only those asthma patients who are prone
ma patients, who are using high doses of ICS, to exacerbations or who need oral steroids for
also take harmfully high doses of oral steroids treatment.
of more than 0.429 per year13. Oral steroids
have devastating effects on a person’s health – In the entire asthma population,
an annual cumulative dose of 2 grams of oral one-quarter of the patients are prone to ex-
steroids is associated with adverse side effects, acerbations, not all of them, but 10% have se-
like diabetes, osteoporosis, arterial hyperten- vere asthma18. Prone to asthma exacerbations
sion, cataracts, depression, but also adrenal means more than two or three (some authors
insufficiency - the side effect of which we are count four - still there is no consensus on the
thinking the least14. number of asthma exacerbations per year). A
patient is said to have suffered from a severe
There are also obstacles and barriers to exacerbation if any of the following are pres-
diagnosing severe asthma patients. Here I re- ent: either systemic steroids had been used to
fer to all kinds of medical doctors, GPs’ and treat the attack, the maintenance dose was re-
all different specialists, including pulmonol- quired to be escalated for at least 3 days; or an
ogists. We have to ask ourselves: are we ap- emergency visit due to asthma had to be made
propriately listening to our patients? Are we to a health-care facility, during which systemic
asking the right questions? Do we perform steroids were administered19. The same severe
objective measurements, like questionnaires, asthma population revealed that more than a
PEF or other lung function measurements, third of those patients do not have asthma ex-
do we detect airflow variability, FeNO, blood acerbation at all. The most important risk fac-
and sputum eosinophilia, skin prick tests etc. tors for asthma exacerbations were BMI, gas-
Are we actively looking for other diseases sim- troesophageal reflux, rhinosinusitis and blood
ilar to severe asthma from a differential diag- eosinophils. Expenses for the 5% of patients
nosis (ANCA test, total and specific IgE to As- prone to exacerbation make up almost 50%
pergillus fumigatus, computed tomography of the total exacerbation burden20. Until now,
HRCT, nasal polyps, drug sensitivities etc)? different cohort analyses did not reveal a sin-
There is a lot of room for improvement in this gle phenotype of patients prone to exacerba-
area. tions21. It seems that patients became prone to
exacerbations when having an increased un-
Extrapolation of results from the data- derlying biological risk, and when he or she is
base to the general Dutch population: there exposed to a certain environment with aller-
are about 6000 patients with severe asthma gens, pollution or stress22.
who are candidates for biologic treatment
– 1.5% of the entire asthma patient popula- There are 30% of patients with severe
tion (13). If we try to estimate the situation for asthma who need oral steroids for their treat-
Croatia, with 4,087,843 inhabitants (accord- ment to prevent their asthma from becoming
ing to the mid-2018 estimate by the Croatian uncontrolled, or for improvement in symp-
Bureau of Statistics) the asthma prevalence is toms and prevention of exacerbations23.
5.28%, as it was shown to be a European prev-
alence15 (although there are epidemiological If we account for these facts, and if this
data that the asthma prevalence in schoolchil- is a similar situation in Croatia (we do not
dren in Croatia is higher - 6.02%–6.9%16,17), have solid statistical data about severe asth-
there are 215,838 asthmatics; among them ma) there are around 3500 patients with se-
vere asthma who are prone to exacerbations
an individualised strategy for the patient dur- ics, which is 10,792 patients. Not all of them
ing the high-risk period after an emergency are candidates for biological therapy; eligible controversies and dilemmas in severe asthma
room or hospital visit. Around 29% of asth- are only those asthma patients who are prone
ma patients, who are using high doses of ICS, to exacerbations or who need oral steroids for
also take harmfully high doses of oral steroids treatment.
of more than 0.429 per year13. Oral steroids
have devastating effects on a person’s health – In the entire asthma population,
an annual cumulative dose of 2 grams of oral one-quarter of the patients are prone to ex-
steroids is associated with adverse side effects, acerbations, not all of them, but 10% have se-
like diabetes, osteoporosis, arterial hyperten- vere asthma18. Prone to asthma exacerbations
sion, cataracts, depression, but also adrenal means more than two or three (some authors
insufficiency - the side effect of which we are count four - still there is no consensus on the
thinking the least14. number of asthma exacerbations per year). A
patient is said to have suffered from a severe
There are also obstacles and barriers to exacerbation if any of the following are pres-
diagnosing severe asthma patients. Here I re- ent: either systemic steroids had been used to
fer to all kinds of medical doctors, GPs’ and treat the attack, the maintenance dose was re-
all different specialists, including pulmonol- quired to be escalated for at least 3 days; or an
ogists. We have to ask ourselves: are we ap- emergency visit due to asthma had to be made
propriately listening to our patients? Are we to a health-care facility, during which systemic
asking the right questions? Do we perform steroids were administered19. The same severe
objective measurements, like questionnaires, asthma population revealed that more than a
PEF or other lung function measurements, third of those patients do not have asthma ex-
do we detect airflow variability, FeNO, blood acerbation at all. The most important risk fac-
and sputum eosinophilia, skin prick tests etc. tors for asthma exacerbations were BMI, gas-
Are we actively looking for other diseases sim- troesophageal reflux, rhinosinusitis and blood
ilar to severe asthma from a differential diag- eosinophils. Expenses for the 5% of patients
nosis (ANCA test, total and specific IgE to As- prone to exacerbation make up almost 50%
pergillus fumigatus, computed tomography of the total exacerbation burden20. Until now,
HRCT, nasal polyps, drug sensitivities etc)? different cohort analyses did not reveal a sin-
There is a lot of room for improvement in this gle phenotype of patients prone to exacerba-
area. tions21. It seems that patients became prone to
exacerbations when having an increased un-
Extrapolation of results from the data- derlying biological risk, and when he or she is
base to the general Dutch population: there exposed to a certain environment with aller-
are about 6000 patients with severe asthma gens, pollution or stress22.
who are candidates for biologic treatment
– 1.5% of the entire asthma patient popula- There are 30% of patients with severe
tion (13). If we try to estimate the situation for asthma who need oral steroids for their treat-
Croatia, with 4,087,843 inhabitants (accord- ment to prevent their asthma from becoming
ing to the mid-2018 estimate by the Croatian uncontrolled, or for improvement in symp-
Bureau of Statistics) the asthma prevalence is toms and prevention of exacerbations23.
5.28%, as it was shown to be a European prev-
alence15 (although there are epidemiological If we account for these facts, and if this
data that the asthma prevalence in schoolchil- is a similar situation in Croatia (we do not
dren in Croatia is higher - 6.02%–6.9%16,17), have solid statistical data about severe asth-
there are 215,838 asthmatics; among them ma) there are around 3500 patients with se-
vere asthma who are prone to exacerbations
