N e w Trea t m e n t s f o r A s t h m a Jenny Huang,
MD
a
, Milind Pansare,
MD
b,
*
KEYWORDS Severe asthma Asthma endotypes Biologics Long-acting antimuscarinic agents Bronchial thermoplasty KEY POINTS Asthma is a complex, heterogeneous chronic airway disease with high prevalence of uncontrolled disease. New therapies, including biologics, are now available to treat T2 high asthma. Treatment of T2 low asthma remains a challenge. Asthma guidelines need be to updated to incorporate new therapeutics.
INTRODUCTION
Asthma was reported as the most prevalent chronic respiratory disease worldwide and had twice as many prevalent cases as chronic obstructive pulmonary disease.1 Globally, the prevalence of asthma increased by 13% to more than 358 million persons from 1990 to 2015.1 In the United States, the prevalence of asthma was estimated at 26 million persons in 2010, with 19 million adults (>18 years) and more than 7 million children (<17 years).2 The total annual costs (including medical care, indirect) for medically treated asthma is estimated at $82 billion.3 Unfortunately, uncontrolled asthma is common and associated with increased costs, increased health care use, and decreased economic productivity.4 To improve care of patients with asthma, in 1991, National Asthma Education and Prevention Program (NAEPP) produced the first expert panel report (EPR) on guidelines for the diagnosis and management of asthma with comprehensive updates. The last guidelines were published in 2007 as EPR-3 report. EPR-3 is a comprehensive scientific evidence-based guideline for delivering best care for adults and children with asthma. It defined goals of asthma treatment as â&#x20AC;&#x153;asthma controlâ&#x20AC;? based on 2 domains: reduce current impairment, defined as â&#x20AC;&#x153;frequency and intensity of symptoms
a Division of Allergy and Immunology, Department of Pediatrics,Childrenâ&#x20AC;&#x2122;s Hospital of Michigan, Suite #4022, 4th Floor, 3950 Beaubien Boulevard, Detroit, MI 48201, USA; b Division of Allergy and Immunology, Department of Pediatrics, Childrenâ&#x20AC;&#x2122;s Hospital of Michigan, Pediatric Specialty Center, Wayne State University, Suite # 4018, 4th Floor, 3950 Beaubien Boulevard, Detroit, MI 48201, USA * Corresponding author. E-mail address: mpansare@dmc.org
Pediatr Clin N Am 66 (2019) 925â&#x20AC;&#x201C;939 https://doi.org/10.1016/j.pcl.2019.06.001 0031-3955/19/ÂŞ 2019 Elsevier Inc. All rights reserved.
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