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http://dx.doi.org/10.4046/trd.2017.0102

Add-on Therapy for Symptomatic Asthma despite Long-Acting Beta-Agonists/Inhaled Corticosteroid  

Dreher, Michael (Division of Pneumology, University Hospital RWTH Aachen)
Muller, Tobias (Division of Pneumology, University Hospital RWTH Aachen)
Publication Information
Tuberculosis and Respiratory Diseases / v.81, no.1, 2018 , pp. 1-5 More about this Journal
Abstract
Asthma, remains symptomatic despite ongoing treatment with high doses of inhaled corticosteroids (ICS) in conjunction with long-acting beta-agonists (LABA), is classified as "severe" asthma. In the course of caring for those patients diagnosed with severe asthma, stepping up from ICS/LABA to more aggressive therapeutic measures would be justified, though several aspects have to be checked in advance (including inhaler technique, adherence to therapy, and possible associated comorbidities). That accomplished, it would be advisable to step up care in accordance with the Global Initiative for Asthma (GINA) recommendations. Possible strategies include the addition of a leukotriene receptor antagonist or tiotropium (to the treatment regimen). The latter has been shown to be effective in the management of several subgroups of asthma. Oral corticosteroids have commonly been used for the treatment of patients with severe asthma in the past; however, the use of oral corticosteroids is commonly associated with corticosteroid-related adverse events and comorbidities. Therefore, according to GINA 2017 these patients should be referred to experts who specialize in the treatment of severe asthma to check further therapeutic options including biologics before starting treatment with oral corticosteroids.
Keywords
Asthma; Biological Products; Interleukin-5; Immunoglobulin E;
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1 Bleecker ER, FitzGerald JM, Chanez P, Papi A, Weinstein SF, Barker P, et al. Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting ${\beta}2$-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial. Lancet 2016;388:2115-27.   DOI
2 Nair P, Wenzel S, Rabe KF, Bourdin A, Lugogo NL, Kuna P, et al. Oral glucocorticoid-sparing effect of benralizumab in severe asthma. N Engl J Med 2017;376:2448-58.   DOI
3 Shirley M. Dupilumab: first global approval. Drugs 2017;77:1115-21.   DOI
4 Pavord ID, Korn S, Howarth P, Bleecker ER, Buhl R, Keene ON, et al. Mepolizumab for severe eosinophilic asthma (DREAM): a multicentre, double-blind, placebo-controlled trial. Lancet 2012;380:651-9.   DOI
5 Ortega HG, Liu MC, Pavord ID, Brusselle GG, FitzGerald JM, Chetta A, et al. Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med 2014;371:1198-207.   DOI
6 Bel EH, Wenzel SE, Thompson PJ, Prazma CM, Keene ON, Yancey SW, et al. Oral glucocorticoid-sparing effect of mepolizumab in eosinophilic asthma. N Engl J Med 2014;371:1189-97.   DOI
7 Castro M, Zangrilli J, Wechsler ME, Bateman ED, Brusselle GG, Bardin P, et al. Reslizumab for inadequately controlled asthma with elevated blood eosinophil counts: results from two multicentre, parallel, double-blind, randomised, placebocontrolled, phase 3 trials. Lancet Respir Med 2015;3:355-66.   DOI
8 Tan LD, Bratt JM, Godor D, Louie S, Kenyon NJ. Benralizumab: a unique IL-5 inhibitor for severe asthma. J Asthma Allergy 2016;9:71-81.
9 Global Initiative for Asthma. Global Strategy for asthma management and prevention, 2017 [Internet]. Bethesda: Global Initiative for Asthma, National Heart, Lung and Blood; 2017 [cited 2017 Oct 1]. Available from: http://www.ginasthma.org.
10 Chung KF, Wenzel SE, Brozek JL, Bush A, Castro M, Sterk PJ, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014;43:343-73.   DOI
11 Melani AS, Bonavia M, Cilenti V, Cinti C, Lodi M, Martucci P, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med 2011;105:930-8.   DOI
12 Lucas AE, Smeenk FW, Smeele IJ, van Schayck CP. Overtreatment with inhaled corticosteroids and diagnostic problems in primary care patients, an exploratory study. Fam Pract 2008;25:86-91.   DOI
13 Aaron SD, Vandemheen KL, Boulet LP, McIvor RA, Fitzgerald JM, Hernandez P, et al. Overdiagnosis of asthma in obese and nonobese adults. CMAJ 2008;179:1121-31.   DOI
14 Boulet LP, Vervloet D, Magar Y, Foster JM. Adherence: the goal to control asthma. Clin Chest Med 2012;33:405-17.   DOI
15 Saunders KB. Misuse of inhaled bronchodilator agents. Br J Med J 1965;1:1037-8.   DOI
16 Boulet LP. Influence of comorbid conditions on asthma. Eur Respir J 2009;33:897-906.   DOI
17 Sanchis J, Gich I, Pedersen S; Aerosol Drug Management Improvement Team (ADMIT). Systematic review of errors in inhaler use: has patient technique improved over time? Chest 2016;150:394-406.   DOI
18 Fink JB, Rubin BK. Problems with inhaler use: a call for improved clinician and patient education. Respir Care 2005;50:1360-74.
19 Muller T, Muller A, Hubel C, Knipel V, Windisch W, Cornelissen CG, et al. Optimizing inhalation technique using web-based videos in obstructive lung diseases. Respir Med 2017;129:140-4.   DOI
20 Virchow JC, Backer V, Kuna P, Prieto L, Nolte H, Villesen HH, et al. Efficacy of a house dust mite sublingual allergen immunotherapy tablet in adults with allergic asthma: a randomized clinical trial. JAMA 2016;315:1715-25.
21 Powell H, Gibson PG. Inhaled corticosteroid doses in asthma: an evidence-based approach. Med J Aust 2003;178:223-5.
22 Sweeney J, Patterson CC, Menzies-Gow A, Niven RM, Mansur AH, Bucknall C, et al. Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry. Thorax 2016;71:339-46.   DOI
23 Vogelmeier C, Kardos P, Hofmann T, Canisius S, Scheuch G, Muellinger B, et al. Nebulised budesonide using a novel device in patients with oral steroid-dependent asthma. Eur Respir J 2015;45:1273-82.   DOI
24 Chauhan BF, Ducharme FM. Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children. Cochrane Database Syst Rev 2012;(5):CD002314.
25 Virchow JC, Mehta A, Ljungblad L, Mitfessel H; MONICA Study Group. Add-on montelukast in inadequately controlled asthma patients in a 6-month open-label study: the MONtelukast In Chronic Asthma (MONICA) study. Respir Med 2010;104:644-51.   DOI
26 Kerstjens HA, Engel M, Dahl R, Paggiaro P, Beck E, Vandewalker M, et al. Tiotropium in asthma poorly controlled with standard combination therapy. N Engl J Med 2012;367:1198-207.   DOI
27 Kerstjens HA, Moroni-Zentgraf P, Tashkin DP, Dahl R, Paggiaro P, Vandewalker M, et al. Tiotropium improves lung function, exacerbation rate, and asthma control, independent of baseline characteristics including age, degree of airway obstruction, and allergic status. Respir Med 2016;117:198-206.   DOI
28 Lefebvre P, Duh MS, Lafeuille MH, Gozalo L, Desai U, Robitaille MN, et al. Acute and chronic systemic corticosteroidrelated complications in patients with severe asthma. J Allergy Clin Immunol 2015;136:1488-95.   DOI
29 Walsh LJ, Wong CA, Oborne J, Cooper S, Lewis SA, Pringle M, et al. Adverse effects of oral corticosteroids in relation to dose in patients with lung disease. Thorax 2001;56:279-84.   DOI
30 Normansell R, Walker S, Milan SJ, Walters EH, Nair P. Omalizumab for asthma in adults and children. Cochrane Database Syst Rev 2014;(1):CD003559.
31 Buhl R, Humbert M, Bjermer L, Chanez P, Heaney LG, Pavord I, et al. Severe eosinophilic asthma: a roadmap to consensus. Eur Respir J 2017;49:1700634.   DOI
32 Pelaia G, Canonica GW, Matucci A, Paolini R, Triggiani M, Paggiaro P. Targeted therapy in severe asthma today: focus on immunoglobulin E. Drug Des Devel Ther 2017;11:1979-87.   DOI
33 Celebi Sozener Z, Aydin O, Misirligil Z, Mungan D, Demirel YS, Celik GE, et al. Omalizumab in non-allergic asthma: a report of 13 cases. J Asthma 2017 Aug 1 [Epub]. https://doi.org/10.1080/02770903.2017.1362427
34 Wenzel S, Castro M, Corren J, Maspero J, Wang L, Zhang B, et al. Dupilumab efficacy and safety in adults with uncontrolled persistent asthma despite use of medium-to-high-dose inhaled corticosteroids plus a long-acting beta2 agonist: a randomised double-blind placebo-controlled pivotal phase 2b dose-ranging trial. Lancet 2016;388:31-44.   DOI