Archives of General Internal Medicine

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Asthma Scholarly Journal

Asthma is a common non-communicable disease with over 300 million people affected worldwide. The proportion of severe asthma of all asthmatics is 5–10%. The GINA (Global Initiative for Asthma) guideline defines severe asthma as a condition that requires GINA step 4 or 5 treatment to be controlled or becomes uncontrolled due to a reduction in this on-going high dose treatment. Uncontrolled asthma is characterised by poor symptom control (frequent symptoms or need of short acting beta agonists, symptoms at night, restricted activity due to asthma) and/or frequent exacerbations (two or more exacerbations requiring per oral corticosteroid (OCS) within a year or 1 or more exacerbations leading to hospitalisation within a year). Important target molecules of biological therapies of severe asthma in use today are the immunoglobulin E (IgE) molecule and the interleukin-5 (IL5) and IL5 receptor (IL5R) molecules. Omalizumab is an anti-IgE antibody and act criteria comprise severe allergic asthma and high serum IgE level and a minimum of one positive skin prick test to an aeroallergen, or elevated specific aeroallergen IgE levels. In the uncontrolled severe allergic asthma patients, omalizumab combined with high dose combination therapy has reduced exacerbations by 25–35%, reduced the use of OCS and symptoms and improved lung function and quality of life. Mepolizumab, reslizumab and benralizumab are anti-IL5 and anti-IL5R-drugs that decrease exacerbations and OCS usage in simple eosinophilic asthma and recover the standard of life with little result on lung function.

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