Author/Authors :
Ansarin، Khalil Ansarin نويسنده Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran , , Attaran، Davood نويسنده , , Jamaati، Hamidreza نويسنده Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran , , Masjedi، Mohammad-Reza نويسنده , , Abtahi، Hamidreza نويسنده Advanced Thoracic Research Center, Pulmonary and Critical Care Department, Imam Khomeini Hospital , , Alavi ، Ali نويسنده Department of Pulmonology, Razi Hospital , , Aliyali، Masoud نويسنده , , Asnaashari ، Amir Mohammad Hashem نويسنده Lung Disease Research Center , , Farid Hosseini، Reza نويسنده , , Ghayumi ، Seyyed Mohammad Ali نويسنده Department of Internal Medicine, Division of Pulmonology, Nemazee Hospital , , Ghobadi، Hassan نويسنده , , Ghotb ، Atabak نويسنده Behphar Scientific Committee, Behphar Group , , Nemati ، Abbas نويسنده Department of Pulmonology , , Rahimi Rad، Mohammad Hossein نويسنده , , Rahimian، Masoud نويسنده , , Sami ، Ramin نويسنده Department of Pulmonary Diseases , , Sohrabpour، Hamid نويسنده , , Tavana، Sasan نويسنده , , TORABI-NAMI، Mohammad نويسنده PhD Candidate, Department of Neuroscience, Institute for Cognitive Science Studies (ICSS), SBMU, Tehran, Iran. , , Vahedi ، Parviz نويسنده Division of Pulmonology, Department of Internal Medicine, Imam Reza Hospital ,
Abstract :
Challenges in the assessment, diagnosis and management of severe, difficult-to-control asthma are increasingly regarded as clinical needs yet unmet. The assessments required to determine asthma severity, comorbidities and confounding factors, disease phenotypes and optimal treatment are among the controversial issues in the field.
The respiratory care experts’ input forum (RC-EIF), comprised of an Iranian panel of experts, reviewed the definition, appraised the available guidelines and provided a consensus for evaluation and treatment of severe asthma in adults.
A systematic literature review followed by discussions during and after the forum, yielded the present consensus. The expert panel used the appraisal of guidelines for research and evaluation-II (AGREE-II) protocol to define an initial locally-adapted strategy for the management of severe asthma.
Severe asthma is considered a heterogeneous condition with various phenotypes. Issues such as assessment of difficult-to-control asthma, phenotyping, the use of blood and sputum eosinophil count, exhaled nitric oxide to guide therapy, the position of anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty as well as the use of established, recently-developed and evolving treatment approaches were discussed and unanimously agreed upon in the panel.
A systematic approach is required to ensure proper diagnosis, evaluate compliance, and to identify comorbidities and triggering factors in severe asthma. Phenotyping helps select optimized treatment. The treatment approach laid down by the Global Initiative for Asthma (GINA) needs to be followed, while the benefit of using biological therapies should be weighed against the cost and safety concerns.
