Figures
- Figure 1
T2 inflammation in asthma and available biologics. DC: dendritic cell; Th0: naïve T-cell; Th2: T-helper 2 cell; B: B-cell; TSLP: thymic stromal lymphopoietin.
- Figure 2
Biomarkers in T2 asthma. Eos: Eosinophil; iNOS: inducible nitric oxide synthase.
Tables
- Table 1
Currently available biologics for T2 asthma
Drug Mechanism Route Omalizumab Anti-IgE Subcutaneous Mepolizumab Anti-IL-5 Subcutaneous Reslizumab Anti-IL-5 Intravenous Benralizumab Anti-IL-5Rα Subcutaneous Dupilumab Anti-IL-4Rα Subcutaneous R: receptor.
- Table 2
Questions selected by the ERS/ATS Severe Asthma Task Force
Should a monoclonal anti-IL-5 antibody be used in adults and children# with severe asthma? Should a measurement of a specific biomarker be used to guide initiation of treatment with a monoclonal anti-IL-5 or IL-5Rα antibody in adults and children with severe asthma? (Chosen biomarkers being FENO, peripheral or sputum eosinophils and serum periostin) Should a measurement of a specific biomarker be used, in addition to total IgE level, to guide initiation of treatment with a monoclonal anti-IgE antibody in adults and children with severe asthma? (Chosen biomarkers being FENO, peripheral or sputum eosinophils and serum periostin) Should an inhaled LAMA be used in adults and children with severe asthma? Should a macrolide (i.e. azithromycin, clarithromycin) be used in adults and children with severe asthma? Should a monoclonal anti-IL-4Rα be used in adults and children with severe asthma? R: receptor. #: for the purposes of this guideline, age >5 years. Reproduced and modified from [6].
- Table 3
Summary of ERS/ATS severe asthma task force recommendations
Question Recommendation Strength Quality of evidence 1 Suggest an anti-IL-5 strategy as add-on therapy for adult patients with severe uncontrolled asthma with an eosinophilic phenotype and for those with severe corticosteroid-dependent asthma Conditional Low 2 Suggest that a blood eosinophil cut-point ≥150 per µL can be used to guide anti-IL-5 initiation in adult patients with severe asthma and a history of prior asthma exacerbations Conditional Low 3 Suggest using a blood eosinophil cut-off ≥260 per µL to identify adolescents (>12 years) and adults with severe allergic asthma more likely to benefit from anti-IgE treatment Conditional Low Suggest using a FENO cut-off ≥19.5 ppb to identify adolescents (>12 years) and adults with severe allergic asthma more likely to benefit from anti-IgE treatment Conditional Low 4 For children, adolescents and adults with severe asthma uncontrolled despite GINA step 4–5 or NAEPP step 5 therapies, recommend the addition of tiotropium Strong Moderate 5 Suggest a trial of macrolide treatment to reduce asthma exacerbations in adult asthma subjects on GINA/NAEPP step 5 therapy that remain persistently symptomatic or uncontrolled Conditional Low Suggest against the use of chronic macrolide treatment in children and adolescents with severe uncontrolled asthma Conditional Low 6 Suggest dupilumab as add-on therapy for adult patients with severe eosinophilic asthma and for those with severe corticosteroid-dependent asthma regardless of eosinophil levels Conditional Low Reproduced and modified from [6].
Vol 16 Issue 2
Table of Contents
Management of severe asthma: summary of the European Respiratory Society/American Thoracic Society task force report
Jump To
- Article
- Abstract
- Abstract
- Background
- The Severe Asthma Task Force of the ERS/ATS
- What questions did the task force consider?
- Should a monoclonal anti-IL5 or antil-IL-5 receptor α-subunit antibody be used in adults and children with severe asthma?
- Should a monoclonal anti-IL-4Rα be used in adults and children with severe asthma?
- Should a LAMA be used in adults and children with severe asthma?
- Should a macrolide be used in adults and children with severe asthma?
- Biomarkers in severe asthma
- Should a specific biomarker be used to initiate treatment with an anti-IL-5 therapy in severe asthma?
- Should measurement of a specific biomarker, in addition to total IgE level, be used to guide initiation of treatment with anti-IgE antibody in severe asthma?
- Conclusions and future perspectives
- Footnotes
- References
- Figures & Data
- Info & Metrics