Severe Asthma

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.

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.

Edited by Antonio Anzueto, Yvonne Heijdra and John R. Hurst COPD is one of the most common diseases worldwide and is projected to be the third leading cause of death by 2020. But that does not mean it is easy to understand or manage. In everyday practice, pulmonologists face areas of controversy in COPD, for which evidence-based medicine is often unavailable. This ERS Monograph considers where the current controversies in COPD lie, discussing areas such as screening, premature birth, asthma–COPD overlap syndrome, treatment, rehabilitation and palliative care. This book will be of great interest to both clinicians and scientists, and aims to stimulate further discussion about this diverse and fascinating disease. "...contains a vast amount of information on the disease, its prevalence, signs and symptoms, diagnositc tests and treatment options. The book's format makes it quick and simple to find out what you need to know, and its size would make it easy to take to work for use in practice [...] invaluable for anyone working with patients with the disease." Emma Vincent, Nursing Standard

This reference collects the latest studies on the development, diagnosis, and treatment of childhood asthma and offers current perspectives on new technologies that will shape the management of pediatric asthma in the forthcoming decade-illustrating how advances in pulmonary function measurement, inflammatory markers, imaging, and pharmacogenetics will enhance the diagnosis and monitoring of asthma in years to come.

The Pocket Book is for use by doctors nurses and other health workers who are responsible for the care of young children at the first level referral hospitals. This second edition is based on evidence from several WHO updated and published clinical guidelines. It is for use in both inpatient and outpatient care in small hospitals with basic laboratory facilities and essential medicines. In some settings these guidelines can be used in any facilities where sick children are admitted for inpatient care. The Pocket Book is one of a series of documents and tools that support the Integrated Managem.

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.

This book presents state of the art knowledge on severe asthma with the aim of providing readers with a clear understanding of, first, the heterogeneity of the condition and of patients’ symptom profiles and responses to therapy and, second, the future implications of this heterogeneity for individualized patient care. After an opening section that offers an overview of severe asthma, including its clinical significance, the pathogenesis, available diagnostic approaches, and treatment options are described in detail. The sections on diagnosis and treatment cover the role of biomarkers, the use of radiologic diagnostic modalities, and both pharmacologic and non-pharmacologic therapies, including emerging options that will address hitherto unmet needs of patients. The outcomes of cutting-edge preclinical and clinical research are carefully documented and numerous useful tips provided on patient management. The inclusion of many informative schematic figures will assist readers in grasping the contents easily. The book will be of high value for medical students, researchers, general physicians, specialists, and paramedical staff.

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.