Page 135 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
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st FDA approval in 2017 for mepolizum- including clinical and laboratory aspects, to- 135
ab, but in a higher dose of 300 mg subcuta- gether with functional tests and imaging, we
neously (sc.), while in Europe it is still not ap- can make a personalized choice of treatment, controversies and dilemmas in severe asthma
proved for this indication of EGPA, and not in with a reasonable chance for significant im-
this higher dose (just in a dose of 100 mg for provement for our severe asthma patients.
severe asthma58). EGPA is always connected Still, there are many controversies and dilem-
with asthma, hyper-eosinophilic syndrome, mas in the field.
often rhinosinusitis with nasal polyps, as well
as damage to two or more organs due to ne- References
crotising vasculitis of small vessels (heart,
lung, skin, kidneys, gastrointestinal or nerv- 1. Soriano JB, Abajobir AA, Abate KH,
ous system). With the purpose of induction et al. Global, regional, and national
or maintenance of remission or preventing re- deaths, prevalence, disability-adjusted
lapse or refractory EGPA, higher dosages of life years, and years lived with disabil-
mepolizumab were applied. Further studies ity for chronic obstructive pulmonary
of EGPA treatment with “asthma-tailored” disease and asthma, 1990-2015: a sys-
dosages (100 mg sc. every 4 weeks (q4 w) in- tematic analysis for the Global Burden
stead of 300 mg sc.q4w) have shown an im- of Disease Study 2015. Lancet Respir
provement also clinically and in reducing ster- Med. 2017 Sep;5(9):691-706.
oid burden. It has been proven that anti-IL-5
treatment (besides mepolizumab, also benral- 2. Lambrecht BN, Hammad H. The im-
izumab59 and reslizumab is not approved for munology of asthma. Nat Immunol.
routine usage for patients yet, but a promising 2015; Jan 16(1):45-56.
clinical trial has been published60) improves
sinonasal scores, reduces asthma symptoms, 3. Aaron SD, Boulet LP, Reddel HK, et
improves lung function, decreases blood eo- al. Underdiagnosis and Overdiagnosis
sinophil count, and significantly decreases of Asthma. Am J Respir Crit Care Med.
steroid dosage. 2018 Oct 15;198(8):1012-20.
Conclusion 4. de Marco R, Cerveri I, Bugiani M, et
al. An undetected burden of asthma in
Severe asthma often has anatypical presenta- Italy: the relationship between clinical
tion, so first, we have to be sure which disease and epidemiological diagnosis of asth-
we are treating, and with which comorbidi- ma. Eur Respir J 1998 Mar;11(3):599-
ties. Efforts should be addressed to adher- 605.
ence, proper inhaler technique, and then the
right treatment to the right patient at the right 5. Enright PL, McClelland RL, New-
time. Due to the heterogeneity of asthma, and man AB, et al. Underdiagnosis and
the fact that some biomarkers do not differ undertreatment of asthma in the elderly.
between clinical phenotypes, clinical pheno- Chest. 1999 Sep;116(3):603-13.
types alone are not precise enough to guide
targeted biological therapy. Mandatory for 6. Jain VV, Allison DR, Andrews S, et al.
the choice of biologicals are biomarkers values, Misdiagnosis Among Frequent Exacer-
total and specific immunoglobulinE (IgE), eo- bators of Clinically Diagnosed Asthma
sinophils in blood and (induced) sputum, as and COPD in Absence of Confirmation
well as fractional exhaled nitric oxide (FeNO). of Airflow Obstruction. Lung. 2015
When we take everything into consideration, Aug;193(4):505-12.
7. Yunginger JW. Diagnostic testing. In:
Kaplan AP, editor. Allergy. 2nd ed.
Philadelphia(PA): Saunders; 1997. p.
326.
8. vanSchayck C, van der Heijden F, van
Den Boom G, et al. Underdiagnosis of
ab, but in a higher dose of 300 mg subcuta- gether with functional tests and imaging, we
neously (sc.), while in Europe it is still not ap- can make a personalized choice of treatment, controversies and dilemmas in severe asthma
proved for this indication of EGPA, and not in with a reasonable chance for significant im-
this higher dose (just in a dose of 100 mg for provement for our severe asthma patients.
severe asthma58). EGPA is always connected Still, there are many controversies and dilem-
with asthma, hyper-eosinophilic syndrome, mas in the field.
often rhinosinusitis with nasal polyps, as well
as damage to two or more organs due to ne- References
crotising vasculitis of small vessels (heart,
lung, skin, kidneys, gastrointestinal or nerv- 1. Soriano JB, Abajobir AA, Abate KH,
ous system). With the purpose of induction et al. Global, regional, and national
or maintenance of remission or preventing re- deaths, prevalence, disability-adjusted
lapse or refractory EGPA, higher dosages of life years, and years lived with disabil-
mepolizumab were applied. Further studies ity for chronic obstructive pulmonary
of EGPA treatment with “asthma-tailored” disease and asthma, 1990-2015: a sys-
dosages (100 mg sc. every 4 weeks (q4 w) in- tematic analysis for the Global Burden
stead of 300 mg sc.q4w) have shown an im- of Disease Study 2015. Lancet Respir
provement also clinically and in reducing ster- Med. 2017 Sep;5(9):691-706.
oid burden. It has been proven that anti-IL-5
treatment (besides mepolizumab, also benral- 2. Lambrecht BN, Hammad H. The im-
izumab59 and reslizumab is not approved for munology of asthma. Nat Immunol.
routine usage for patients yet, but a promising 2015; Jan 16(1):45-56.
clinical trial has been published60) improves
sinonasal scores, reduces asthma symptoms, 3. Aaron SD, Boulet LP, Reddel HK, et
improves lung function, decreases blood eo- al. Underdiagnosis and Overdiagnosis
sinophil count, and significantly decreases of Asthma. Am J Respir Crit Care Med.
steroid dosage. 2018 Oct 15;198(8):1012-20.
Conclusion 4. de Marco R, Cerveri I, Bugiani M, et
al. An undetected burden of asthma in
Severe asthma often has anatypical presenta- Italy: the relationship between clinical
tion, so first, we have to be sure which disease and epidemiological diagnosis of asth-
we are treating, and with which comorbidi- ma. Eur Respir J 1998 Mar;11(3):599-
ties. Efforts should be addressed to adher- 605.
ence, proper inhaler technique, and then the
right treatment to the right patient at the right 5. Enright PL, McClelland RL, New-
time. Due to the heterogeneity of asthma, and man AB, et al. Underdiagnosis and
the fact that some biomarkers do not differ undertreatment of asthma in the elderly.
between clinical phenotypes, clinical pheno- Chest. 1999 Sep;116(3):603-13.
types alone are not precise enough to guide
targeted biological therapy. Mandatory for 6. Jain VV, Allison DR, Andrews S, et al.
the choice of biologicals are biomarkers values, Misdiagnosis Among Frequent Exacer-
total and specific immunoglobulinE (IgE), eo- bators of Clinically Diagnosed Asthma
sinophils in blood and (induced) sputum, as and COPD in Absence of Confirmation
well as fractional exhaled nitric oxide (FeNO). of Airflow Obstruction. Lung. 2015
When we take everything into consideration, Aug;193(4):505-12.
7. Yunginger JW. Diagnostic testing. In:
Kaplan AP, editor. Allergy. 2nd ed.
Philadelphia(PA): Saunders; 1997. p.
326.
8. vanSchayck C, van der Heijden F, van
Den Boom G, et al. Underdiagnosis of
