Asthma Yardstick Annals of Allergy, Asthma & Immunology

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Presentation transcript:

Asthma Yardstick Annals of Allergy, Asthma & Immunology Bradley E. Chipps, MD, Jonathan Corren, MD, Elliot Israel, MD, Rohit Katial, MD, David M. Lang, MD, Reynold A. Panettieri, MD, Stephen P. Peters, MD, PhD, Judith R. Farrar, PhD Annals of Allergy, Asthma & Immunology Volume 118, Issue 2, Pages 133-142.e3 (February 2017) DOI: 10.1016/j.anai.2016.12.010 Copyright © 2016 American College of Allergy, Asthma & Immunology Terms and Conditions

Figure 1 Step therapy for adult patients with asthma adapted from the 2015 Global Initiative for Asthma guidelines.1 *Tiotropium by soft-mist inhaler is indicated as add-on treatment for patients with a history of exacerbations; it is not indicated in children younger than 18 years old. **For patients prescribed beclomethasone/formoterol or budesonide/formoterol. IL indicates interleukin; LTRA, leukotriene receptor antagonist; OCS, oral corticosteroid. Annals of Allergy, Asthma & Immunology 2017 118, 133-142.e3DOI: (10.1016/j.anai.2016.12.010) Copyright © 2016 American College of Allergy, Asthma & Immunology Terms and Conditions

Figure 2 When should a sustained step-up in asthma therapy be considered?1 FEV1 indicates forced expiratory volume in 1 second; PEF, peak expiratory flow. Annals of Allergy, Asthma & Immunology 2017 118, 133-142.e3DOI: (10.1016/j.anai.2016.12.010) Copyright © 2016 American College of Allergy, Asthma & Immunology Terms and Conditions

Figure 3 The Asthma Yardstick flowchart. The patient profiles and recommendations for treatment are based on current guidelines and newer data and the authors' clinical experience as described in the text. *Symptomatic indicates poorly or not well-controlled asthma according to a validated instrument, such as the Asthma Control Test, the Asthma Control Questionnaire or the Asthma Therapy Assessment Questionnaire. **Before stepping up therapy, assess the patient for nonadherence, potential comorbidities, and other factors that might negatively affect response to therapy (Table 1) and to confirm that the increased level of symptoms is attributable to asthma. ***Persistent eosinophilic inflammation and recurrent exacerbations may be indicators of poor adherence with therapy in patients with difficult-to-treat asthma. Consideration should be given to observing high-dose inhaled corticosteroid (ICS) therapy with monitoring of fractional exhaled nitric oxide before initiating therapy with biologics in patients in whom this might be a consideration.15 GINA indicates Global Initiative for Asthma; ICS, inhaled corticosteroid; IL, interleukin; LABA, long-acting β2-agonist; LTRA, leukotriene receptor antagonist; OCS, oral corticosteroid; SRT, sustained-release theophylline. Annals of Allergy, Asthma & Immunology 2017 118, 133-142.e3DOI: (10.1016/j.anai.2016.12.010) Copyright © 2016 American College of Allergy, Asthma & Immunology Terms and Conditions

eFigure 1 Type 2 inflammation endotypes in asthma (adapted from Stokes and Casalee7). IL indicates interleukin; PGD2, prostaglandin D2. Annals of Allergy, Asthma & Immunology 2017 118, 133-142.e3DOI: (10.1016/j.anai.2016.12.010) Copyright © 2016 American College of Allergy, Asthma & Immunology Terms and Conditions