Severe Asthma in Primary Care: Identification and Management

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Severe Asthma in Primary Care: Identification and Management Jennifer L. Trevor, MD, Bradley E. Chipps, MD The American Journal of Medicine Volume 131, Issue 5, Pages 484-491 (May 2018) DOI: 10.1016/j.amjmed.2017.12.034 Copyright © 2018 The Authors Terms and Conditions

Figure 1 Definition of severe asthma based on the International European Respiratory Society and American Thoracic Society Task Force guidelines.3 ACQ = Asthma Control Questionnaire; ACT = Asthma Control Test; FEV1 = forced expiratory volume in 1 second; GINA = Global Initiative for Asthma; ICS = inhaled corticosteroid; ICU = intensive care unit; LABA = long-acting β2-agonist. The American Journal of Medicine 2018 131, 484-491DOI: (10.1016/j.amjmed.2017.12.034) Copyright © 2018 The Authors Terms and Conditions

Figure 2 Overview of inflammatory cytokine pathways and signaling in type 2 asthma. Type 2 cytokines (interleukin [IL]-4, IL-5, and IL-13) recruit effector cells (eg, eosinophils) and mediate B-cell class switching to produce immunoglobulin E (IgE) upon exposure to antigens. Cytokines also play a central role in the hallmark effects of asthma.30 Adapted with permission from John Wiley & Sons Ltd from Robinson D, Humbert M, Buhl R, et al. Revisiting type 2–high and type 2–low airway inflammation in asthma: current knowledge and therapeutic implications. Clin Exp Allergy. 2017;47:161-175. © 2017 The Authors. Th2 cell = T helper type 2 cells. The American Journal of Medicine 2018 131, 484-491DOI: (10.1016/j.amjmed.2017.12.034) Copyright © 2018 The Authors Terms and Conditions

Figure 3 Example of a patient with severe asthma illustrating evidence-based treatment recommendations for step-up therapy. ACE = angiotensin-converting enzyme; ACQ = Asthma Control Questionnaire; ACT = Asthma Control Test; ICS = inhaled corticosteroid; LABA = long-acting β2-agonist; LAMA = long-acting muscarinic antagonist; OCS = oral corticosteroid; SABA = short-acting β2-agonist. The American Journal of Medicine 2018 131, 484-491DOI: (10.1016/j.amjmed.2017.12.034) Copyright © 2018 The Authors Terms and Conditions