Is it severe asthma or asthma with severe comorbidities?
Received 31 August 2017
Accepted for publication 23 October 2017
Published 29 November 2017 Volume 2017:10 Pages 303—305
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Amrita Dosanjh
Luisa Brussino,1 Paolo Solidoro,2 Giovanni Rolla1
1Allergy and Clinical Immunology, University of Torino and Mauriziano Hospital, 2SC Pneumologia U, AOU Città della Salute e della Scienza, Torino, Italy
Abstract: Severe asthma is defined as asthma that requires treatment with high-dose inhaled corticosteroids (ICSs) plus a second controller and/or systemic corticosteroids to prevent it from becoming uncontrolled or that remains uncontrolled despite this therapy. This definition has limitations: 1) it does not define any biological characteristic that distinguishes severe asthma from asthma in general and 2) it relies on the clinical interpretation of asthma symptoms that are not specific. Actually, wheezing, dyspnea, cough and chest tightness may be caused by the comorbidities (such as rhinosinusitis, obesity and vocal cord dysfunction [VCD]) which are associated with asthma. In clinical practice, clinicians are often prone to diagnose uncontrolled asthma and increase doses of ICSs without considering the comorbidities, resulting in poor control of symptoms. This commentary wishes the clinicians to focus on the comorbidities of asthma, particularly in patients with severe asthma, because the correct diagnosis of these comorbidities implies specific treatments that lead to a better asthma control.
Keywords: severe asthma, chronic rhinosinusitis, obesity, vocal cord dysfunction, dupilumab
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