Difficult Asthma and its Treatment

Year 2017, Volume: 9 Issue: 2, 39 - 47, 15.03.2017

Prof. Dr. Bülent Enis Şekerel

Abstract

Abstract

Difficult asthma accounts for 5-10% of asthmatic patients but a great deal of mor-bidity and expenditures due to asthma belongs to this group of patients. The definition is still contraversial; patients with poor asthma control or frequent exacerbations with high-dose anti-asthma drugs are defined as ‘difficult asthma’. It may be difficult to assess this complex and mixed patient group under standard outpatient conditions. These patients should be evaluated systematically in centers special for asthma. There are well defined phenotypes according to history, pathophysiology, clinical features and treatment response. Knowing these phenotypes makes targeted treatment possible. In the treatment plan, firstly, we must be sure of asthma diagnosisand exclude the alternative diseases. Secondly, all the triggerinf factors that may disrupt asthma control should be removed, and comorbid diseases such as rhinosinusitis and gastroesophageal reflux should be treated. In addition to conventional asthma drugs, monoclonal antibodies such as omalizumab, macrolides, bronchial thermoplasty and newly developed biological agents can be used for treatment.

Keywords

Difficult asthma, phenotype, comorbidity, treatment

Zor Astım ve Tedavisi

Abstract

Öz

Zor astım, astımlı hastaların %5-10 ‘unu oluşturmakla birlikte astıma bağlı morbidite ve harcamaların büyük bir kısmı bu gruba aittir. Zor astım tanımı tartışmalıdır, yüksek doz astım tedavisine rağmen semptom kontrolü sağlanamayan, sık alevlenme yaşayan hastalar bu gruba girmektedir. Bu en kompleks ve karışık hasta grubunu standart poliklinik koşullarında değerlendirmek zor olabilir, hastalar astıma özelmerkezlerde sistematik bir şekilde değerlendirilmelidir. Öykü, patofizyoloji, kliniközellikler ve tedavi cevaplarına göre iyi tanımlanmış zor astım fenotipleri vardır, bu fenotiplerin bilinmesi hedeflenmiş tedaviyi mümkün kılabilir. Zor astım tedavi planında öncelikle astım tanısından emin olunmalı, ayırıcı tanı yapılmalıdır. Astım kont-rolünü bozabilecek olan tüm tetikleyici faktörler ortadan kaldırılmalı, rinosinüzit, gastroözefageal reflü gibi komorbid hastalıklar tedavi edilmelidir. Zor astımda konvansiyonel astım ilaçlarının yanı sıra omalizumab gibi monoklonal antikorlar, makrolidler,  bronşial termoplasti ve yeni geliştirilen biyolojik ajanlar kullanılabilir.

Keywords

Zor astım, fenotip, komorbidite, tedavi

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