Page 33 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Introduction
Severe asthma is a term that encompasses all forms of asthma that do not respond to standard therapy comprising of high doses of inhaled corticosteroids in combination with other medications including long-acting beta-2-agonists and leukotriene receptor antagonists [1]. It is considered a heterogeneous disease in which a variety of clinical, physiological and inflammatory markers determine disease severity [2]. Pivotal studies in the last 5 years have led to substantial progress in various areas, including a more accurate definition of truly severe refractory asthma [3;4], and classification of the disease into distinct clinical phenotypes. An accurate definition of severe asthma is important to exclude patients with a wrong diagnosis or those who have uncontrolled asthma because of unaddressed or untreated aggravating factors. Furthermore, clinical phenotyping is mandatory to predict asthma outcome, to better understand the mechanisms of disease and to target specific treatment.
This article will provide you with directions on how to make a correct diagnosis of truly severe refractory asthma, how to better recognize and address the pathogenetic factors that are operative in a given clinical phenotype, and how to identify the best treatment for patients with severe, refractory asthma taking the specific phenotypes into account.
Diagnostic workup: wrong diagnosis and aggravating factors
The first step towards adequate treatment of a patient with severe asthma is to establish a secure diagnosis and to address and remove factors that may aggravate or complicate the disease [3].
Wrong diagnosis
There are many conditions that may mimic severe asthma and some patients may not have asthma at all. In a case study where difficult-to-treat adult asthma patients were systemically assessed, 12% of the patients were judged to have a diagnosis other than asthma, such as chronic obstructive pulmonary
Current treatment of severe asthma
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