Difficult-to-Treat and Severe Asthma

Abstract Introduction: The purpose of this article is to describe the characteristics, comorbidities and phenotypes of patients with difficult-to-treat asthma (DTA) and severe asthma (SA). Materials and Methods: Descriptive, cross-sectional study of patients evaluated at the Difficult-to-Treat Asthma Clinic of the Hospital Británico within the period of one year. We registered the age, gender and anthropometric data, age of diagnosis, FEV1 at the beginning of follow-up and previous exacerbations. We evaluated symptom control with the Asthma Control Test and the Asthma Control Questionnaire. We registered the comorbidities and evaluated the inflammatory profile of patients according to blood biomarker measurements and induced sputum sample. Results: Forty patients, 20 DTA and 20 SA. There weren't any significant differences regarding age, BMI, age of onset of symptoms, symptom control or FEV1 at the beginning of follow-up. Crises were more common in SA patients. The most commonly found co morbidities were obesity, OSAHS and gastroesophageal reflux disease. Psychiatric disorders were more common in SA patients. The most commonly found phenotype was allergen-reactive TH2. Discussion and Conclusion: it is not easy to classify both groups, and many times there are overlapping characteristics. Comor bidities are frequent in both groups: obesity, OSAHS and reflux disease are the most common conditions. Being able to identify the asthma phenotype in order to target the treatment.

Treatment of Severe Asthma / 대한내과학회지

Severe asthma represents 3–10% of all cases of asthma, but accounts for > 60% of total asthma-related medical costs. Uncontrolled asthma symptoms and frequent asthma exacerbations associated with severe asthma have profound adverse effects on patients' quality of life. The concepts of difficult-to-treat asthma and severe asthma are different; severe asthma represents one kind of difficult-to-treat asthma. Misdiagnosis, nonadherence, and comorbidities may also be causes of difficult-to-treat asthma. This review discusses important principles in the treatment of difficult-to-treat asthma and severe asthma.