TY - JOUR T1 - Update on severe asthma: what we know and what we need JF - European Respiratory Review JO - EUROPEAN RESPIRATORY REVIEW SP - 58 LP - 65 DO - 10.1183/09059180.00001009 VL - 18 IS - 112 AU - M. Gaga AU - E. Zervas AU - P. Chanez Y1 - 2009/06/01 UR - http://err.ersjournals.com/content/18/112/58.abstract N2 - Severe asthma patients experience frequent or debilitating symptoms and limitations in their activities, have frequent exacerbations and hospitalisations and account for over half of the cost of the disease and most of its mortality [1, 2]. Because the disease is chronic, debilitating and may prove fatal, it is imperative to understand the mechanisms and factors associated with it and to treat it effectively. This update on severe asthma presents information regarding epidemiology, clinical assessment, risk factors, pathophysiology and management of severe asthma and includes recent relevant publications.According to the Global Initiative for Asthma (GINA) definition, patients who experience daily symptoms, frequent exacerbations, frequent nocturnal asthma symptoms, limitation of physical activities, forced expiratory volume in 1 s (FEV1) or peak expiratory flow (PEF) 60% predicted and PEF or FEV1 variability >30% before initiation of treatment should be classified as having severe persistent asthma [1, 2]. Once treatment is initiated, the response to treatment is also important and is measured by the level of control. This dual assessment creates some confusion as the terminology is not standardised and the terms are often used interchangeably [3]. However, both concepts of asthma severity and control are important in the evaluation of patients and their response to treatment: some patients respond to treatment and become asymptomatic while others remain uncontrolled. Therefore, the diagnosis of “severe asthma” or “severe refractory asthma” is based on both the clinical features of the disease and the daily medication regimen that the patient is receiving. Patients who need oral corticosteroids or very high dose inhaled steroids to remain under control as well as patients with ongoing asthma symptoms, despite being on the appropriate maintenance therapy (high dose inhaled corticosteroids (ICS) combined with long-acting β2-agonists (LABA)), should be … ER -