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- W2019998349 abstract "#### Summary pointsThere is no universally accepted definition of difficult asthma. However, it is reasonable to consider it present when people have persistent symptoms and frequent exacerbations, despite being treated at steps 4 or 5 of the British Thoracic Society and Scottish Intercollegiate Guideline Network (BTS/SIGN) guidelines (fig 1⇓).1 Such patients typically receive high dose inhaled steroids (≥800 µg beclometasone equivalent), a long acting β2 agonist, plus add-on treatment. The prevalence of difficult asthma is uncertain, but it may account for 5-10% of adults with asthma.2 Morbidity and health costs are disproportionately high in these patients,w1 and they are at greater risk of fatal and near fatal exacerbations.w2 In addition, frequent, intermittent, or continuous courses of oral prednisolone (plus regular high dose inhaled steroids) increase the risk of steroid related adverse effects.#### Sources and selection criteriaAll authors performed a comprehensive search of articles published up to January 2009 using PubMed and Medline. Keywords and phrases used were “asthma”, “exacerbations”, “symptoms”, “difficult asthma”, “lung function”, “diagnosis”, “bronchial hyper-responsiveness”, “nitric oxide”, “sputum eosinophils”, “treatment”, “monitoring”, “inhaled steroids”, “long acting β2 agonists”, “leukotriene receptor antagonists”, “bronchial thermoplasty”, “immunoglobulin E therapy”, and “tumour necrosis factor”.Fig 1 Simplified diagram of the pharmacological management of chronic asthma in adults1 w1Several key questions must be considered before prescribing add-on treatments and higher …" @default.
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- W2019998349 date "2009-02-24" @default.
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- W2019998349 title "Difficult to treat asthma in adults" @default.
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