Лечение рекомендации и Американского тяжелой Европейского торакального бронхиальной респираторного общества астмы: общества

Translated title of the contribution: Management of severe asthma: A European Respiratory Society/American Thoracic Society guideline

Fernando Holguin, Juan Carlos Cardet, Kian Fan Chung, Sarah Diver, Diogenes S. Ferreira, Anne Fitzpatrick, Mina Gaga, Liz Kellermeyer, Sandhya Khurana, Shandra Knight, Vanessa M. McDonald, Rebecca L. Morgan, Victor E. Ortega, David Rigau, Padmaja Subbarao, Thomy Tonia, Ian M. Adcock, Eugene R. Bleecker, Chris Brightling, Louis Philippe BouletMichael Cabana, Mario Castro, Pascal Chanez, Adnan Custovic, Ratko Djukanovic, Urs Frey, Betty Frankemölle, Peter Gibson, Dominique Hamerlijnck, Nizar Jarjour, Satoshi Konno, Huahao Shen, Cathy Vitary, Andy Bush

Research output: Contribution to journalReview articlepeer-review


This document provides clinical recommendations for the management of severe asthma. Comprehensive evidence syntheses, including metaanalyses, were performed to summarise all available evidence relevant to the European Respiratory Society/American Thoracic Society Task Force’s questions. The evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of asthma experts, who made specific recommendations on six specific questions. After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made the following recommendations: • suggest using anti-interleukin (IL)-5 and anti-IL-5 receptor α for severe uncontrolled adult eosinophilic asthma phenotypes; • suggest using a blood eosinophil cut-point ≥150 μL−1 to guide anti-IL-5 initiation in adult patients with severe asthma; • suggest considering specific eosinophil (≥260 μL−1) and exhaled nitric oxide fraction (≥19.5 ppb) cut-offs to identify adolescents or adults with the greatest likelihood of response to anti-IgE therapy; • suggest using inhaled tiotropium for adolescents and adults with severe uncontrolled asthma despite Global Initiative for Asthma (GINA) step 4 – 5 or National Asthma Education and Prevention Program (NAEPP) step 5 therapies; • suggest a trial of chronic macrolide therapy to reduce asthma exacerbations in persistently symptomatic or uncontrolled patients on GINA step 5 or NAEPP step 5 therapies, irrespective of asthma phenotype; • suggest using anti-IL-4/13 for adult patients with severe eosinophilic asthma and for those with severe corticosteroid-dependent asthma regardless of blood eosinophil levels. These recommendations should be reconsidered as new evidence becomes available.

Translated title of the contributionManagement of severe asthma: A European Respiratory Society/American Thoracic Society guideline
Original languageRussian
Pages (from-to)272-295
Number of pages24
Issue number3
StatePublished - 2021
Externally publishedYes

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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