Article Figures & Data
Figures
- Figure 1
- Pathogenesis of severe asthma. IL: interleukin, TSLP: thymic stromal lymphopoietin, ILC-2: innate lymphoid cell type 2; RORA: related orphan receptor A, Th2: T-helper cell-2, IgE: immunoglobulin E, HLC: histamine-leukotrienes-cytokines.
- Figure 1
- Definition and classification of difficult asthma ICS: inhaled corticosteroids; OCS: oral corticosteroids
Tables
Diagnostic study Test Radiology • Chest x-ray • Chest CT • Gastrointestinal assessment (PH/impedance probe, barium studies, or scoping) • Bronchoscopy (flexible versus rigid) with Bronchoalveolar lavage Blood and serological test • CBC with differential looking for eosinophilia • Total IgE • Skin prick testing or specific IgE measurement • Immunoglobulin level Others • Sweat chloride test • Spirometry (including post bronchodilatation, lung volumes) • Sleep studies • Genetic testing IgE: immunoglobulin E, CBC: complete blood count, CT: computed tomography
• Allergic rhinitis • Sleep-disordered breathing • EILO/VCD • GERD • Obesity • Eosinophilic esophagitis • ABPA VCD: vocal cord dysfunction, EILO: exercise-induced laryngeal obstruction, GERD: gastroesophageal reflux disease, ABPA: allergic bronchopulmonary aspergillosis
Drug Dose and route Indication Mechanism of action Dupilumab (Dupixent) 400-600 mg SC loading dose followed by 200 or 300 mg SC every 2 wk ≥12 yr old; AEC ≥150 cells/µL or FeNO ≥25 ppb with OCS-dependent Anti–IL-4R; binds to IL-4 receptor α; blocks signaling of IL-4 and IL-13 Benralizumab (Fasenra) 30 mg SC every 4 wk for three doses; followed by every 8 wk subsequently ≥18 yr old; severe eosinophilic asthma Anti–IL-5; binds to IL-5 receptor α; causes apoptosis of eosinophils and basophils Reslizumab (Cinqair) Weight-based dosing of 3 mg/kg IV every 4 wk ≥18 yr old; AEC ≥400 cells/µL Anti–IL-5; binds to IL-5 ligand; prevents IL-5 from binding to its receptor Mepolizumab (Nucala) 100 mg SC every 4 week ≥6 yr old; AEC ≥150 cells/µL or ≥300 cells/µL at least once a year Anti–IL-5; binds to IL-5 ligand; prevents IL-5 from binding to its receptor Omalizumab (Xolair) Based on weight and total IgE, SC every 2-4 wk ≥6 yr old; positive allergy testing (allergic asthma); IgE, 30–1500 IU/mL Anti-IgE; prevents IgE from binding to its receptor on mast cells and basophils IV: Intravenous, SC: subcutaneous, IgE: immunoglobulin E, wk: week, yr: year, IL: interleukin, ACE: absolute eosinophil count, FeNO: fractional nitric oxide
In this issue
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- Article
- Abstract
- 1. Introduction
- 2. Methods
- 3. Definition
- 4. Burden and epidemiology of severe asthma
- 5. Pathogenesis of severe asthma
- 6. Evaluation of severe asthma in children
- 7. Biological treatment of severe asthma in children
- 8. Other medications used for severe asthma
- 9. Impact of severe asthma on children’s quality of life
- 10. Requirements
- 10. Conclusion
- Acknowledgment
- Footnotes
- References
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- eLetters
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