According to new international guidelines regarding asthma and its severity, severe asthma is defined as “asthma which requires treatment with high dose inhaled corticosteroids (ICS) plus a second controller – long-acting ?2 agonist (LABA), leukotriene modifier, theophylline or systemic corticosteroids – to prevent it from becoming uncontrolled or which remains uncontrolled despite this therapy.”

The new guideline is the result of a joint effort from the European Respiratory Society and the American Thoracic Society. The guideline provides an updated definition of severe asthma, along with new recommendations for treating the condition. It also provides a detailed discussion of the phenotyping of patients with severe asthma as evidence suggests severe asthma affects people in different ways.

“This new guideline provides a platform to help us understand severe asthma and how to treat it,” said co-lead author, Professor Fan Chung, from Imperial College London and the Royal Brompton Hospital. “As the evidence available for the field of severe asthma is only just emerging, we must take the opportunity to build on this knowledge and increase our efforts to ultimately provide personalized medicine to people with this condition.”

Recommended in the document is the use of the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) method on the evaluation and treatment of severe asthma. Recommendations were made on five treatments that have been used or proposed for use in severe asthma namely anti-IgE treatment, methotrexate, anti-fungal treatment, macrolide antibiotics, and bronchial thermoplasty.