Diagnosis of severe asthma

Area of Science:

• Pulmonology
• Allergy and Immunology

Background:

• Severe asthma affects patients inadequately controlled by high-intensity medication, presenting diagnostic challenges in primary and specialist care.
• Novel, expensive treatments exist for therapy-resistant asthma, necessitating careful patient selection.
• A structured diagnostic evaluation is essential to differentiate biologically severe asthma from cases manageable by addressing contributing factors.

Purpose of the Study:

• To outline a three-step diagnostic evaluation process for severe asthma.
• To guide the identification of patients who require novel therapies versus those who may benefit from managing contributory factors.
• To provide a practical approach for implementing these diagnostic measures in primary and secondary care settings.

Main Methods:

• Confirmation of asthma diagnosis using objective evidence of variable airflow obstruction.
• Systematic management of contributory factors, including non-adherence, inhaler technique, triggers, and comorbidities.
• Phenotyping and endotyping of patients diagnosed with severe asthma.

Main Results:

• The proposed three-step approach provides a structured method for evaluating patients with severe asthma.
• Distinguishes between patients with true biologically severe asthma and those with uncontrolled asthma due to modifiable factors.
• Facilitates appropriate referral and selection for novel, advanced asthma therapies.

Conclusions:

• A rigorous, multi-step diagnostic evaluation is vital for optimizing the management of severe asthma.
• Addressing contributory factors and precise phenotyping/endotyping are key to appropriate treatment selection.
• This systematic approach supports effective care delivery in both primary and specialist settings for severe asthma patients.