A multidisciplinary European Respiratory Society (ERS) and American Thoracic Society (ATS) task force of asthma experts have developed updated clinical recommendations for the management of severe asthma.
The guidelines, published in the European Respiratory Journal, were initiated in light of the rapid introduction of new treatments for severe asthma, including new biological treatments that have been approved for the management of severe eosinophilic asthma.
Using the PICO approach (patient population, intervention, comparator and outcome) the task force committee established six key questions that the recommendations are centred on, which were not addressed in previous guidelines. The questions include:
- Should a monoclonal anti-IL-5 antibody be used in adults and children with severe asthma?
- Should a measurement of a specific biomarker be used to guide initiation of treatment with a monoclonal anti-IL-5 or IL-5Rα antibody in adults and children with severe asthma?
- Should a measurement of a specific biomarker be used, in addition to total IgE level, to guide initiation of treatment with a monoclonal anti-IgE antibody in adults and children with severe asthma?
- Should a long-acting inhaled muscarinic antagonist be used in adults and children with severe asthma?
- Should a macrolide (i.e. azithromycin, clarithromycin) be used in adults and children with severe asthma?
- Should a monoclonal anti-IL-4Rα be used in adults and children with severe asthma?
Systematic reviews and application of the GRADE approach (grading of recommendations, assessment, development and evaluation) were performed by members of the task force to assess the strength of evidence used as the basis of the recommendations.
Each section follows a comprehensive and clear structure that provides a summary of the evidence relevant to the question, benefits and harms, conclusions and research needs, a brief discussion of ‘what others are saying’, the ERS/ATS recommendations and additional remarks.
The task force group say the recommendations should lead to modifications of guidelines and improvement in outcomes that are important to patients, such as reductions in oral corticosteroid dose and exacerbation frequency, and improved quality of life.
However, they conclude that the recommendations may not be effective across all severe asthma patients, and say that more precise phenotype-driven research is needed in the future.