Schweres Asthma

Zusammenfassung

Die europäische und die amerikanische Pneumologengesellschaft veröffentlichte die Leitlinie zur Definition, Evaluation und Therapie des schweren Asthmas. Angestrebt werden standardisierte Diagnosekriterien und die Entwicklung evidenzbasierter diagnostischer und therapeutischer Strategien. Für die Etablierung der Diagnose sind die Verifizierung der Asthmadiagnose und die Erfassung von Komorbiditäten und krankheitsbegünstigenden Faktoren von zentraler Bedeutung. Die Steroidinsensitivität und die Überdosierung von inhalativen Betamimetika stellen eine typische Herausforderung im praktischen Alltag dar. Neue Therapiestrategien eröffnen die Perspektive auf eine personalisierte Asthmatherapie

Abstract

The European Respiratory Society and the American Thoracic Society recently published the international ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. It is aim of the guideline to establish standardized diagnostic criteria and to develop evidence based diagnostic and therapeutic strategies. In the diagnostic approach verifying the diagnosis of asthma and identifying comorbidities and contributing factors are very important. In the therapeutic guidance of asthma patients steroid insensitivity and overdosage of betamimetic inhaler therapy are typical challenges. Novel therapeutic strategies open the perspective to personalized therapy in asthma

Schlüsselwörter

unkontrolliertes Asthma - Steroidsensitivität - Komorbiditäten

Keywords

uncontrolled asthma - steroid insensivity - comorbidities

• Literatur

• 1 Chung KF, Wenzel SE, Brozek JL et al. International ERS / ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014; 43: 343-373
• 2 Dahlen B, Nizankowska E, Szczeklik A et al. Benefits from adding the 5-lipoxygenase inhibitor zileuton to conventional therapy in aspirin-intolerant asthmatics. Am J Respir Crit Care Med 1998; 157: 1187-94
• 3 Davies H, Olson L, Gibson P. Methotrexate as a steroid sparing agent for asthma in adults. Cochrane Database Syst Rev 2000; Cd000391
• 4 Haldar P, Pavord ID, Shaw DE et al. Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med 2008; 178: 218-224
• 5 Juniper EF, O‘Byrne PM, Guyatt GH et al. Development and validation of a questionnaire to measure asthma control. Eur Respir J 1999; 14: 902-907
• 6 Kerstjens HA, Disse B, Schroder-Babo W et al. Tiotropium improves lung function in patients with severe uncontrolled asthma: a randomized controlled trial. J Allergy Clin Immunol 2011; 128: 308-314
• 7 Kerstjens HA, Engel M, Dahl R et al. Tiotropium in asthma poorly controlled with standard combination therapy. N Engl J Med 2012; 367: 1198-1207
• 8 Moore WC, Bleecker ER, Curran-Everett D et al. Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Instituteʼs Severe Asthma Research Program. J Allergy Clin Immunol 2007; 119: 405-413
• 9 Moore WC, Meyers DA, Wenzel SE et al. Identification of asthma phenotypes using cluster analysis in the Severe Asthma Research Program. Am J Respir Crit Care Med 2010; 181: 315-323
• 10 Peters SP, Kunselman SJ, Icitovic N et al. Tiotropium bromide step-up therapy for adults with uncontrolled asthma. N Engl J Med 2010; 363: 1715-1726
• 11 Robinson DS, Campbell DA, Durham SR et al. Systematic assessment of difficult-to-treat asthma. Eur Respir J 2003; 22: 478-483
• 12 Rodrigo GJ, Castro-Rodriguez JA. Anticholinergics in the treatment of children and adults with acute asthma: a systematic review with meta-analysis. Thorax 2005; 60: 740-746
• 13 Suissa S, Ernst P, Boivin JF et al. A cohort analysis of excess mortality in asthma and the use of inhaled beta-agonists. Am J Respir Crit Care Med 1994; 149: 604-610
• 14 Thomas M, Kay S, Pike J et al. The Asthma Control Test (ACT) as a predictor of GINA guideline-defined asthma control: analysis of a multinational cross-sectional survey. Prim Care Respir J 2009; 18: 41-49
• 15 van Veen IH, Ten Brinke A, Sterk PJ et al. Exhaled nitric oxide predicts lung function decline in difficult-to-treat asthma. Eur Respir J 2008; 32: 344-349