This book provides a practical, stepwise, evidence-based approach to effective management of patients with difficult to treat asthma. The impact of asthma on morbidity and healthcare utilization increases exponentially with severity. Severe refractory asthma accounts for less than 5% of all asthma. Its prevalence, however, is often overestimated as there are several other confounding factors that make asthma ‘difficult to treat’. Many novel (albeit expensive) therapies are now available and providers caring for patients with severe asthma are charged with selecting the best evidence treatment. This calls for complex and nuanced decision-making. Whether people with asthma gain and maintain control over their condition depends not only on the availability of effective drugs, but also multiple patient and healthcare provider behaviors. Therefore, now more than ever, it has become increasingly important to differentiate “difficult” from “severe refractory” asthma to allow identification of patients most likely to benefit from these therapies.
This volume delves into the current understanding of mechanisms and increasingly recognized heterogeneity of this complex disease. It discusses a structured approach to identification and optimization of factors contributing to poor asthma control, including nonadherence, comorbidities and occupational/environmental triggers. The book includes ‘state of the art’ reviews on recent advances in traditional and targeted asthma therapies, as well as a glimpse into what the future may hold. Highlights include a comprehensive guide to management of severe asthma in children and pregnancy, as well as practical considerations to management of asthma based on different clinical phenotypes. Each chapter is authored by leading experts in the field who share their own clinical approach. This is an ideal guide for clinical pulmonologists and allergist/immunologists, as well as primary care providers, physician extenders in specialty practice, physicians in pulmonary/allergy training, and even industry partners.
About the Author
Sandhya Khurana, MD is an Associate Professor of Medicine at the University of Rochester and the Co-Director of Mary Parkes Center for Asthma, Allergy & Pulmonary Care. Dr. Khurana is an adult pulmonologist with a specialized focus in management of severe and difficult to treat asthma. She is the immediate past chair of the Airways Disorders NetWork of the American College of Chest Physicians. Dr. Khurana has chaired asthma-focused sessions and participated as faculty at national and international meetings. She also serves on the American Thoracic Society and European Respiratory Society joint taskforce on severe asthma.
Fernando Holguin, MD., MPH., is Professor of Medicine and Pediatrics and the Director of the Asthma Clinical and Research Programs at the University of Colorado. Dr Holguin has been involved in asthma clinical and translational research for over 20 years. His research work primarily focuses on the intersection of obesity and asthma. Dr. Holguin co-chairs the American Thoracic Society and European Respiratory Society taskforce on Severe Asthma.
Table of Contents
Chapter 1: Scope of the problem, definition and pathophysiology
Chapter 2: Is it Asthma? Recognizing asthma mimics
Chapter 3: Beyond Refills: Promoting Adherence to Optimize Outcomes
Chapter 4: Addressing Comorbidities in Difficult Asthma
Chapter 5: Evaluation and Management of Work-Related Asthma
Chapter 6: Advances in Inhaled Medications
Chapter 7: Heterogeneity in Severe asthma
Chapter 8: Biomarkers, Targeted Therapies, Biologics and Bronchial Thermoplasty
Chapter 9: Practical Considerations in Management of Allergic Asthma
Chapter 10: Practical considerations in the management of eosinophilic asthma
Chapter 11: Practical considerations in management of non-eosinophilic asthma
Chapter 12: Practical considerations in management of obesity associated asthma
Chapter 13: Severe asthma in pregnancy: Special considerations
Chapter 14: Severe asthma in childhood: Special considerations
Chapter 15: High-risk asthma clinic: Putting it all together
Chapter 16: Difficult Asthma: Unmet Needs and Future Directions