Management of Severe Asthma An Update M.Moin M.D Professor of Allergy & Clinical Immunology Immunology, Asthma & Allergy Research Institute IAARI Children's Medical Center Tehran University of Medical Sciense 1392 2014 ” رد خ و ان دج داون ام ج هنب“
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Management of Severe Asthma An Update
M.Moin M.DProfessor of Allergy & Clinical ImmunologyImmunology, Asthma & Allergy Research Institute
IAARI
Children's Medical CenterTehran University of Medical Sciense
1392
2014
” خرد و جان خداوند نام “به
Severe Asthma : Many Clinical phenotypes!
Subgroups :Severe Asthma / Refractory AsthmaDifficult to control asthmaPoorly controlled asthmaSteroid-dependent & /or Steroid resistant
asthmaBrittle asthma Irreversible asthmaFatal or Near-fatal asthmaATS & ERS joint workshop consensusAm J Respir Care Med,162:2341-51,2000
Diagnostic Criteria for Severe AsthmaATS – ERS Joint Workshop Consensus -2000
Diagnosis : One or both major criteria & Two minor criteria
Major criteria
In order to achieve control(mild-mod , persistent asthma) :1. Rx with continuous or near continuous(≥50% of the year)2. Rx with high dose I.C.S(1000ug Fluticasone/BDP)
ATS & ERS joint workshop consensusAm J Respir Care Med,162:2341-51,2000
Diagnostic Criteria for Severe AsthmaATS – ERS Joint Workshop Consensus -2000
ATS & ERS joint workshop consensusAm J Respir Care Med,162:2341-51,2000
Diagnostic Criteria for Severe AsthmaATS – ERS Joint Workshop Consensus -2000
Minor criteria,Cot'd
4. ≥1 ED visist/year5. ≥3 OCS/year6. Prompt deterioration with ≤25%
↓ICS/OCS7. Near-fatal asthma in the past.
ATS & ERS joint workshop consensusAm J Respir Care Med,162:2341-51,2000
WHO Definition of Severe Asthma
• Severe asthma includes 3groups: - Untreated severe asthma- Difficult-to-treat severe asthma- Treatment-resistant severe asthma
1- Asthma for which control is not achieved despite the highest level of recommended treatment: refractory asthma and corticosteroid-resistant asthma2- Asthma for which control can be maintained only with the highest level of recommended treatment.
–Bousquet J, Mantzouranis E, Cruz AA, Ait-Khaled N, Baena-Cagnani CE, Bleek ER, et alUniform definition of asthma severity, control, and exacerbation: document presented for the World Health Organization Consultation on Severe Asthma. J Allergy Clin Immunol 2010;126:926-38.–Desai D, Brightling C, Cytokine and anti- Cytokine therapy in asthma: ready for the chinic? Clin Exp Immunol 2009;158:10-9
Therapy- resistant asthmaStill symptomatic even when
basic management issues resolved
DDx. With Difficult asthma
References
1. Assembly on asthma of the Spanish Society of Pulmonology and Thoracic Surgery.Guidelines for the Diagnosis and Management of difficult-to-control Asthma.Arch Brononeumol 2005:41(9) :513-523
2. Fitzgerald JM,Shahidi N , Achieving asthma control in patients with moderate disease .J Allergy Clin immunnol 2010;125:307-311.
3. Ayres JG et al.Brittle asthma .Paed Resp Reviews.2004;5:40-444. Wenzel S, Szefler SJ, Managing severe asthma , J Allrgy Clin
Immunol 2006;117:505-511.5.Moin M et al. Risk Factors Leading to Hospital Admission in Iranian
Asthmatic Children .Int Arch Allergy Immunol 2008;145:244-248 6.Moin et al Acta Medica; Risk Factors For Asthmatic Children