Challenges in the Management of Severe Asthma: Role of Current and Future Therapies

Ron      Oliveinstein; Hamdan      Al Jahdali; Nouf      Alkhamis; Rabih      Halwani; Saleh      Al-Muhsen; Qutayba      Hamid

Abstract

Severe asthma is a complex and heterogeneous phenotype characterized by persistent symptoms and poor control. While some patients respond to high doses of inhaled corticosteroids in combination with long-acting beta-agonists, a significant subset require oral corticosteroids to achieve symptom control. This issue has led to the development of alternative therapeutic strategies for severe asthma. This article provides an overview of current therapeutic strategies and suggests how they can be best applied to the treatment of severe asthma. The article then reviews alternative therapeutic strategies including macrolide antibiotics, biologic agents, modulators of signal transduction pathways and bronchial thermoplasty. The challenge remains to determine the appropriate phenotype for each therapeutic strategy in view of the heterogeneity of severe asthma.

Keywords: Severe asthma, new asthma therapy, corticosteriods, macrolides, biologic agents, neutrophilic, beta2, obliterans, emphysema, pulmonary edema, eosinophilic pneumonia, ABPA, Churg-Strauss syndrome, benign, malignant tumors, co-morbidities, cigarette smoking, anti-inflammatory therapy, synergistically