Author/Authors :
Ansarin, Khalil tabriz university of medical sciences - Tuberculosis and Lung Disease Research Center, ايران , Attaran, Davood mashhad university of medical sciences - Lung Disease Research Center, ايران , Jamaati, Hamidreza shahid beheshti university of medical sciences - Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD),, تهران, ايران , Masjedi, Mohammad Reza shahid beheshti university of medical sciences - Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD),, تهران, ايران , Abtahi, Hamidreza tehran university of medical sciences tums - Advanced Thoracic Research Center, Pulmonary and Critical Care Department, Imam Khomeini Hospital, تهران, ايران , Alavi, Ali guilan university of medical sciences - Department of Pulmonology, Razi Hospital, ايران , Aliyali, Masoud mazandaran university of medical sciences - Department of Internal Medicine, Pulmonary and Critical Care Division, ايران , Asnaashari, Amir Mohammad Hashem mashhad university of medical sciences - Lung Disease Research Center, ايران , Farid-Hosseini, Reza mashhad university of medical sciences - Allergy Research Center, School of Medicine, ايران , Ghayumi, Seyyed Mohammad Ali shiraz university of medical sciences - Department of Internal Medicine, Division of Pulmonology, Nemazee Hospital, ايران , Ghobadi, Hassan ardabil university of medical sciences - Department of Internal Medicine, Pulmonary Division, School of Medicine, ايران , Ghotb, Atabak Behphar Scientific Committee, Behphar Group, ايران , Nemati, Abbas Artesh University of Medical Sciences - Department of Pulmonology, ايران , Rahimi Rad, Mohammad Hossein urmia university of medical sciences - Department of Pulmonary Medicine, Imam Khomeini hospital, ايران , Rahimian, Masoud yazd shahid sadoghi university of medical sciences - Department of Internal medicine, Division of Pulmonary and Critical Care Medicine, ايران , Sami, Ramin Qazvin Medical University Science, Shahid Bahonar - Department of Pulmonary Diseases, ايران , Sohrabpour, Hamid shahid beheshti university of medical sciences - Department of Pulmonary Medicine, تهران, ايران , Tavana, Sasan shahid beheshti university of medical sciences - Clinical Research Development Center, Shahid Modarres Hospital, تهران, ايران , Torabi-Nami, Mohammad shiraz university of medical sciences - Department of Neuroscience, School of Advanced Medical Sciences and Technologies, ايران , Vahedi, Parviz mashhad university of medical sciences - Division of Pulmonology, Department of Internal Medicine, Imam Reza Hospital, ايران
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.
