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JACI Highlights - March 2006
Moore et al - Severe Asthma: An Overview
Asthma is a common disease that is rising in prevalence worldwide. Although severe asthma represents less than 10 percent of all asthma, these patients are responsible for a disproportionate share of the health care costs and morbidity associated with the disease. A significant challenge in the management of severe asthma is the ability to accurately identify, characterize, and then treat these patients. Multiple studies have shown that both patients and physicians inaccurately estimate disease severity leading to the under-treatment of patients. In the March 2006 issue of the Journal of Allergy and Clinical Immunology Drs. Moore and Peters examine our current understanding of "true" severe asthma and the methods used to assess disease severity, to identify patients with severe asthma at risk for adverse outcomes, and to assess response to therapy and the clinical stability of the disease. To improve the treatment of patients with severe asthma, our understanding of the mechanisms responsible for severe disease must be improved. To achieve this goal it is imperative to develop a common definition of severe asthma to allow adequate characterization of the disease clinically and provide the opportunity to compare results from many studies. The current review discusses previous studies that have described subsets of severe asthma patients ("phenotypes") who share common clinical characteristics or show similar types of inflammation in the lung. Although these phenotypes have not been confirmed in large populations and are likely evolve over time, it may be instructive to use these descriptions to guide treatment of severe asthma patients today. The authors discuss the use of novel testing methods to assess lung inflammation to assess disease severity and asthma control to guide therapy.
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