Difficult To Treat Asthma

This book provides a practical, stepwise, evidence-based approach to effective management of patients with difficult to treat asthma. The impact of asthma on morbidity and healthcare utilization increases exponentially with severity. Severe refractory asthma accounts for less than 5% of all asthma. Its prevalence, however, is often overestimated as there are several other confounding factors that make asthma ‘difficult to treat’. Many novel (albeit expensive) therapies are now available and providers caring for patients with severe asthma are charged with selecting the best evidence treatment. This calls for complex and nuanced decision-making. Whether people with asthma gain and maintain control over their condition depends not only on the availability of effective drugs, but also multiple patient and healthcare provider behaviors. Therefore, now more than ever, it has become increasingly important to differentiate “difficult” from “severe refractory” asthma to allow identification of patients most likely to benefit from these therapies. This volume delves into the current understanding of mechanisms and increasingly recognized heterogeneity of this complex disease. It discusses a structured approach to identification and optimization of factors contributing to poor asthma control, including nonadherence, comorbidities and occupational/environmental triggers. The book includes ‘state of the art’ reviews on recent advances in traditional and targeted asthma therapies, as well as a glimpse into what the future may hold. Highlights include a comprehensive guide to management of severe asthma in children and pregnancy, as well as practical considerations to management of asthma based on different clinical phenotypes. Each chapter is authored by leading experts in the field who share their own clinical approach. This is an ideal guide for clinical pulmonologists and allergist/immunologists, as well as primary care providers, physician extenders in specialty practice, physicians in pulmonary/allergy training, and even industry partners.

Severe asthma is a form of asthma that responds poorly to currently available medication, and its patients represent those with greatest unmet needs. In the last 10 years, substantial progress has been made in terms of understanding some of the mechanisms that drive severe asthma; there have also been concomitant advances in the recognition of specific molecular phenotypes. This ERS Monograph covers all aspects of severe asthma – epidemiology, diagnosis, mechanisms, treatment and management – but has a particular focus on recent understanding of mechanistic heterogeneity based on an analytic approach using various ‘omics platforms applied to clinically well-defined asthma cohorts. How these advances have led to improved management targets is also emphasised. This book brings together the clinical and scientific expertise of those from around the world who are collaborating to solve the problem of severe asthma.

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Most patients with asthma are easily diagnosed and treated with the use of an inhaler or medication. Approximately five per cent of people that suffer from asthma have ‘difficult’ or ‘refractory’ asthma, whereby they experience persistent problems that are not controlled by standard treatment methods. Part of the Clinical Focus Series, this book provides a complete overview of difficult asthma, discussing the clinical assessment and management of this complex condition. Beginning with the epidemiology and characteristics of severe asthma, the book defines current understanding of the immunological mechanisms and disease heterogeneity. It also offers insight into how the condition can affect the physical and psychological aspects of a person’s life. Separate chapters examine novel therapeutic strategies and the economic burden of refractory asthma. Key points Discusses clinical assessment and management of difficult asthma Includes epidemiology, immunology, physical and psychological effects, economic burden and novel therapeutics Internationally renowned author and editor team

Asthma is a long-term condition that reduces the amount of air flowing in and out of the lungs. Whether your symptoms are mild, difficult-to-control or severe, it is important to be in control of your asthma. The information in this booklet is designed to help you and your family better understand the condition, what triggers it and how to treat it. It includes clear instructions for good inhaler technique and emphasizes the importance of having an Asthma Action Plan in place so that you know: • when and how often to take your treatment • how to tell if your symptoms are getting worse • what to do when your symptoms get worse. With simple clear illustrations, explanation of medical terms and space to write down the questions you want to ask your doctor or nurse, this resource will help you take control of your asthma. Contents: • What is asthma? • What causes asthma? • What are the symptoms of asthma? • What are the tests for asthma? • What medications are used to treat asthma? • Inhalers and spacers • Your Asthma Action Plan • How do I prevent an asthma attack? • How do I manage an asthma attack? • Difficult-to-control asthma • Severe asthma • Treatment of severe asthma • Exercise-induced asthma • Occupational asthma • Asthma in older people • Asthma in pregnancy • Asthma in children

This book provides readers with a comprehensive review of severe asthma in children and adolescents, covering epidemiology, genetics, risk factors, co-morbidities, clinical presentation, diagnosis and treatment. Written by leaders in the field, chapter discussions draw on the mechanisms driving the disease, genetics, multidisciplinary approaches, immunomodulators, and other important aspects in the management of the disease. Severe Asthma in Children and Adolescents: Mechanisms and Management is designed to be a practical guide, opening with an introduction on the epidemiology of severe childhood asthma, as well as a discussion of special considerations of the disease unique to the preschool-aged patient. The distinctions between the diagnosis and management of asthma in young children of various ages, and specific approaches for the adolescent with severe asthma, including the transition into adult care are then addressed. Finally, the book closes with a discussion on the current state and future avenues for severe asthma research. Severe Asthma in Children and Adolescents is an indispensable reference for the healthcare professional, for basic and translational researchers, as well as for students, residents and fellows.

Globally, severe asthma is defined by the WHO as either (A) untreated severe asthma; (B) difficult-to-treat severe asthma; and (C) treatment-resistant severe asthma. Untreated severe asthma is a political problem: the children do not have access to the basic tools for asthma management, and when this is corrected, asthma outcomes are transformed. The problem in difficult-to-treat severe asthma is not the airway disease, but co-morbidities and behavioral factors. This is the group in which there are most asthma deaths, underscoring that severe asthma cannot be solely defined by levels of prescribed therapy. Treatment-resistant severe asthma is rare and challenging, and the problem is the airway pathology. These children require new and innovative therapies.

Personalized medicine is a rapidly emerging area in health care, and asthma management lends itself particularly well to this new development. This practical resource by Dr. Stanley J. Szefler helps you navigate the many asthma medication options available to your patients, as well as providing insights into those which may be introduced within the next several years. Features a wealth of information on available asthma medications, including new immunomodulators, new responses to treatment, and new treatment strategies at all levels of asthma care. Prepares you to meet your patients’ needs regarding asthma exacerbation prevention and asthma prevention. Consolidates today’s available information and guidance in this timely area into one convenient resource.