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Treatment of severe asthma in adolescents and adults

Sally Wenzel, MD
Section Editor
Bruce S Bochner, MD
Deputy Editor
Helen Hollingsworth, MD


The classification of "severe asthma" refers to patients who require high dose inhaled glucocorticoid (GC), or continuous or near continuous oral GC treatment to maintain asthma control or who never achieve control despite that treatment (table 1) [1].

The National Asthma Education and Prevention Program (NAEPP) and Global Initiative for Asthma (GINA) guidelines have a slightly different category of "severe persistent asthma" that describes patients who have frequent and severe asthma symptoms and evidence of airflow limitation, but are not on asthma controller medication (table 2) [2,3]. Patients with severe asthma (by European Respiratory Society [ERS]/American Thoracic Society [ATS] criteria) generally require high doses of controller medications to achieve control [1]; without these medications their asthma is either "not well controlled" or "very poorly controlled" by NAEPP/GINA criteria (table 3).

The evaluation of patients with severe asthma symptoms, a general overview of asthma management, and a review of nonpharmacologic management are presented separately. (See "Evaluation of severe asthma in adolescents and adults" and "An overview of asthma management" and "Trigger control to enhance asthma management".)

Treatment issues that pertain to patients with severe asthma are reviewed here. Treatment approaches to mild and moderate persistent asthma are reviewed separately. (See "An overview of asthma management" and "Treatment of intermittent and mild persistent asthma in adolescents and adults" and "Treatment of moderate persistent asthma in adolescents and adults".)


Treatment of severe asthma frequently requires a multidisciplinary approach to address patient education needs, remediate irritant and allergic triggers, treat comorbidities, and design an optimal medication regimen.

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Literature review current through: Nov 2017. | This topic last updated: Nov 13, 2017.
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