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Severe asthma: advances in current management and future therapy.

Abstract
Effective treatment of severe asthma is a major unmet need because patients' symptoms are not controlled on maximum treatment with inhaled therapy. Asthma symptoms can be poorly controlled because of poor adherence to controller therapy, and this might be addressed by using combination inhalers that contain a corticosteroid and long-acting β(2)-agonist as reliever therapy in addition to maintenance treatment. New bronchodilators with a longer duration of action are in development, and recent studies have demonstrated the benefit of a long-acting anticholinergic bronchodilator in addition to β(2)-agonists in patients with severe asthma. Anti-IgE therapy is beneficial in selected patients with severe asthma. Several new blockers of specific mediators, including prostaglandin D(2), IL-5, IL-9, and IL-13, are also in clinical trials and might benefit patients with subtypes of severe asthma. Several broad-spectrum anti-inflammatory therapies that target neutrophilic inflammation are in clinical development for the treatment of severe asthma, but adverse effects after oral administration might necessitate inhaled delivery. Macrolides might benefit some patients with infection by atypical bacteria, but recent results are not encouraging, although there could be an effect in patients with predominant neutrophilic asthma. Corticosteroid resistance is a major problem in patients with severe asthma, and several molecular mechanisms have been described that might lead to novel therapeutic approaches, including drugs that could reverse this resistance, such as theophylline and nortriptyline. In selected patients with severe asthma, bronchial thermoplasty might be beneficial, but thus far, clinical studies have not been encouraging. Finally, several subtypes of severe asthma are now recognized, and in the future, it will be necessary to find biomarkers that predict responses to specific forms of therapy.
AuthorsPeter J Barnes
JournalThe Journal of allergy and clinical immunology (J Allergy Clin Immunol) Vol. 129 Issue 1 Pg. 48-59 (Jan 2012) ISSN: 1097-6825 [Electronic] United States
PMID22196524 (Publication Type: Journal Article, Review)
CopyrightCopyright © 2012 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
Chemical References
  • Adrenal Cortex Hormones
  • Anti-Asthmatic Agents
  • Anti-Inflammatory Agents
  • Antibodies, Anti-Idiotypic
  • Bronchodilator Agents
  • anti-IgE antibodies
Topics
  • Administration, Inhalation
  • Adrenal Cortex Hormones (administration & dosage, therapeutic use)
  • Anti-Asthmatic Agents (administration & dosage, therapeutic use)
  • Anti-Inflammatory Agents (therapeutic use)
  • Antibodies, Anti-Idiotypic (therapeutic use)
  • Asthma (drug therapy)
  • Bronchodilator Agents (administration & dosage, therapeutic use)
  • Humans
  • Nebulizers and Vaporizers
  • Severity of Illness Index

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