Severe asthma diagnos1cs and management
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1 Clinical Village Sta1on 10 Severe asthma diagnos1cs and management Pneumonologist exclusion/treatment of other lung diseases (COPD, ABPA, ILD, bronchiectasis, fibrosis, EGPA, ) ENT sinusitis vocal cord dysfunction psychotherapy internist heart failure GERD Guiding pa1ents & treatment control GINA steps 1-5 allergic asthma: an@- IgE, itraconazole (!moulds), an@- IL- 13?, an@- IL- 4? eosinophilic asthma: an@ IL- 5, an@- IgE, an@- IL- 4, an@ IL- 13? non- eosinophilic: macrolides, thermoplasty?, immunomodulators? documenta1on (registries, e.g. Pa1ent good adherence ð good asthma control Management of severe asthma needs a mul@disciplinary team. Phenotyping of severe asthma is important for treatment. Pa@ent educa@on and self- management is a central component.
2 Clinical Village StaHon 10 Treatment of asthma GINA omalizumab (an- IgE), + mepulizumab (an- IL- 5) other op-on: + oral steroid J Step 5 med/high ICS/LABA + -otropium - LAMA Other op-on: theopyhllin Step 4 + long ac-ng beta- agonists - LABA Other op-on: + leucotrien antagonists Step 3 short ac-ng beta- agonists- SABA + ICS (inhaled steroid) Step 2 other op-on: leucotrien antagonists (LTRA) L short ac-ng beta- mime-cs on demand - SABA other op-on: controller (ICS) Step 1 Self- management and training, treat comorbidi-es and risk factors (avoidance of allergens, smoking cessa-on) Step up & step down Give as much medica-on as needed to maintain asthma control, but as few medica-on as needed.
3 Clinical Village StaHon 10 Barbara Böckle, Innsbruck; Norbert Reider, Dpt. of Dermatology, Innsbruck, Austria; Dpt. of Pediatrics; Eva- Maria Varga, Dpt. of Pediatrics, Medical University of Graz, Austria Treatment of asthma GINA omalizumab (an- IgE), + mepulizumab (an- IL- 5) other op-on: + oral steroid J Step 5 med/high ICS/LABA + -otropium - LAMA Other op-on: theopyhllin Step 4 + long ac-ng beta- agonists - LABA Other op-on: + leucotrien antagonists Step 3 short ac-ng beta- agonists- SABA + ICS (inhaled steroid) Step 2 other op-on: leucotrien antagonists (LTRA) L short ac-ng beta- mime-cs on demand - SABA other op-on: controller (ICS) Step 1 Self- management and training, treat comorbidi-es and risk factors (avoidance of allergens, smoking cessa-on) Step up & step down Give as much medica-on as needed to maintain asthma control, but as few medica-on as needed.
4 Clinical Village Sta(on 10 Lung func(on tes(ng Spirometry - the basis of lung func6on tes6ng assessment for flow restric6ons diagnosing for bronchial obstruc6on Bronchodilator response tes6ng for reversible obstruc6on by inhala6on of beta- mime6cs Body plethysmography assessment of total volumes (TLC) and flow restric6ons diagnosing for restric6on and obstruc6on Bronchoprovoca(on (metacholin, histamine) diagnosing for bronchial hyperreac6vity Diffusing capacity diagnosing for inters66al pathology (e.g. pulmonary fibrosis) Spiroergometry func6onal tes6ng for restricted exercise capacity, diagnosing for O2 uptake, CO2 breathing and lactate increase in blood the following parameters can be assessed by lung func6on tes6ng Bronchial obstruc6on and bronchial hyperreac6vity Bronchodilator response to beta- mime6cs Restric6on and inters66al pathology
5 Clinical Village Sta1on 10 Severe asthma diagnos1cs and management Defini1on of Severe Asthma (ERS/ATS) Treatment with GINA steps 4-5 High dose ICS combina2on therapy (LABA, LTRA or theoph.) OCS > 50 % of previous year Uncontrolled or uncontrolled with treatment reduc1on Management of Severe Asthma For the diagnosis of severe asthma, difficult asthma has to be ruled out, comorbidi2es treated and pa2ent managed by specialist for 3 mo Biomarkers (non- invasiveness and stability) to phenotype asthma
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