Severe asthma: Current and future treatments
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7th Pneumonology Department and Asthma Centre, Athens Chest Hospital, Athens, Greece
Institute for Lung Health, University of Leicester, Glenfield Hospital, UK
Eleftherios Zervas   

7th Pneumonology Dept. and Asthma Centre, Athens Chest Hospital, Mesogion Ave. 152, 11527 Athens, Greece
Pneumon 2011;24(4):405–416
Most forms of asthma can be controlled by inhaled corticosteroids (ICS), but a substantial number of patients still experience symptoms and limitations in their personal and social life despite being on appropriate maintenance therapy. These patients with severe asthma account for almost half of the cost of the disease and most of its morbidity and mortality. To date, the use of ICS and long acting bronchodilators (LABAs) is the basis of severe asthma treatment, but the optimal use and dosage of these drugs should be determined based on the available evidence. Anti-immunoglobulin E (anti-IgE) has been recently established for the treatment of patients with severe allergic asthma whose symptoms are inadequately controlled with ICS/LABA. The use of long-acting anticholinergics (LAMA) as add-on therapy is currently under investigation in clinical trials. Alternative forms of treatment, such as macrolide therapy, have produced conflicting results, while an approach based on anti-tumour necrosis factor-α (anti-TNFα) has proven ineffective. The targeted inhibition of interleukin (IL) 2, IL 4, IL 5, IL-9 and IL 13 is currently being investigated. A nondrug treatment, bronchial thermoplasty (BT), has been reported to provide some benefits to patients with severe asthma, but the long-term benefit/risk ratio for BT is unknown at present. In view of the heterogeneity of severe asthma, the present challenge is to determine the appropriate phenotype for current and innovative forms of treatment. 
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