Fast Five Quiz: Type 2 Inflammation in Severe Asthma

Zab Mosenifar, MD


January 20, 2021

Figure 1. Asthma pathology. An illustration of lungs with a normal airway (left) and an inflamed, constricted, asthmatic airway showing mucus buildup (right).

Asthma is considered severe when the condition is uncontrolled despite adherence to maximal optimized therapy and treatment of contributory factors or worsens when high-dose treatment is decreased. Patients with severe asthma often feel isolated because their symptoms are more disruptive than those of patients with mild or moderate asthma.

Asthma is managed through a step-wise approach. For patients with uncontrolled, severe persistent asthma, management recommendations include:

  • Step 5: The preferred controller medication is a high-dose inhaled corticosteroid (ICS) and a leukotriene receptor antagonist. Omalizumab may be considered for patients who have allergies.

  • Step 6: Add oral corticosteroids (OCS) if the combination recommended in step 5 (a high-dose ICS and a leukotriene receptor antagonist) does not control the asthma. Omalizumab may be considered for patients who have allergies.

Severe persistent asthma is characterized as:

  • Continuous symptoms of cough, wheezing, chest tightness, or difficulty breathing;

  • Frequent nighttime symptoms;

  • Lung function test FEV1 is 60% or less than normal values;

  • And peak flow is marked by more than 30% variability.

Presence of one severe feature is sufficient to diagnose severe persistent asthma. It is also important to note that asthma is broadly classified, and patients may experience mild, moderate, or severe exacerbations, regardless of the level of asthma with which they were diagnosed. Some patients with intermittent asthma may suffer from severe flare-ups punctuated by periods of nearly normal lung function (however, they are likely to experience the effects of long-term inflammation.)

For asthma patients with persistent symptoms and/or exacerbations refractory to high-dose ICS, clinical or inflammatory phenotype should be assessed. Results may inform the selection of add-on therapy.

Learn more about the staging of asthma.


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