Allergy Asthma Immunol Res.  2019 Nov;11(6):763-778. 10.4168/aair.2019.11.6.763.

Future Risks in Patients With Severe Asthma

Affiliations
  • 1Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. swj0126@amc.seoul.kr
  • 2Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
  • 3College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Korea.
  • 4National Heart & Lung Institute, Imperial College London & Royal Brompton and Harefield NHS Trust, London, United Kingdom.

Abstract

A major burden of severe asthma is the future risk of adverse health outcomes. Patients with severe asthma are prone to serious exacerbation and deterioration of lung function and may experience side effects of medications such as oral corticosteroids (OCSs). However, such future risk is not easily measurable in daily clinical practice. In particular, currently available tools to measure asthma control and asthma-related quality of life incompletely predict the future risk of medication-related morbidity. This is a significant issue in asthma management. This review summarizes the current evidence of future risk in patients with severe asthma. As future risk is poorly perceived by controlled asthmatics, our review focuses on the risk in patients with "˜controlled' severe asthma. Of note, it is likely that long-term OCS therapy may not prevent future asthma progression, including lung function decline. In addition, the risk of drug side effects increases even during low-dose OCS therapy. Thus, novel treatments are highly desirable for reducing future risks without any loss of asthma control.

Keyword

Asthma; severity; risk

MeSH Terms

Adrenal Cortex Hormones
Asthma*
Drug-Related Side Effects and Adverse Reactions
Humans
Lung
Quality of Life
Adrenal Cortex Hormones

Figure

  • Fig. 1 Concepts of asthma control, asthma severity and future risk in severe asthmatics. Unlike other adverse asthma outcomes, future risk of medication side effects are not readily measurable in daily clinical practice for severe asthma.

  • Fig. 2 Different future risks in patients with severe asthma according to their control status. The red line denotes a high likelihood of a relationship. The grey dotted line indicates an uncertain likelihood (lack of evidence for the relationship).


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