Regina Maria de Carvalho-Pinto1, José Eduardo Delfini Cançado2, Marcia Margaret Menezes Pizzichini3, Jussara Fiterman4, Adalberto Sperb Rubin5,6, Alcindo Cerci Neto7,8, Álvaro Augusto Cruz9,10, Ana Luisa Godoy Fernandes11, Ana Maria Silva Araujo12, Daniela Cavalet Blanco13, Gediel Cordeiro Junior14,15, Lilian Serrasqueiro Ballini Caetano11, Marcelo Fouad Rabahi16, Marcelo Bezerra de Menezes17, Maria Alenita de Oliveira18, Marina Andrade Lima19, Paulo Márcio Pitrez20
J Bras Pneumol.2021;47(6):e20210273
Advances in the understanding that severe asthma is a complex and heterogeneous disease and in the knowledge of the pathophysiology of asthma, with the identification of different phenotypes and endotypes, have allowed new approaches for the diagnosis and characterization of the disease and have resulted in relevant changes in pharmacological management. In this context, the definition of severe asthma has been established, being differentiated from difficult-to-control asthma. These recommendations address this topic and review advances in phenotyping, use of biomarkers, and new treatments for severe asthma. Emphasis is given to topics regarding personalized management of the patient and selection of biologicals, as well as the importance of evaluating the response to treatment. These recommendations apply to adults and children with severe asthma and are targeted at physicians involved in asthma treatment. A panel of 17 Brazilian pulmonologists was invited to review recent evidence on the diagnosis and management of severe asthma, adapting it to the Brazilian reality. Each of the experts was responsible for reviewing a topic or question relevant to the topic. In a second phase, four experts discussed and structured the texts produced, and, in the last phase, all experts reviewed and approved the present manuscript and its recommendations.
Keywords: Asthma/therapy; Asthma/drug therapy; Asthma/prevention & control; Antibodies, monoclonal, humanized.