Severe asthma: adding new evidence - Latin American Thoracic Society.

This document constitutes a summary of the clinical practice guidelines (CPGs) prepared at the initiative of the Latin American Thoracic Society (ALAT). Due to new evidence in the treatment of severe asthma, it was agreed to select six clinical questions, and the corresponding recommendations are provided herein. After considering the quality of the evidence, the balance between desirable and undesirable impacts and the feasibility and acceptance of procedures, the following recommendations were established. 1) We do not recommend the use of an inhaled corticosteroid (ICS) plus formoterol as rescue medication in the treatment of severe asthma. 2) We suggest performing many more high-quality randomised studies to evaluate the efficacy and safety of tiotropium in patients with severe asthma. 3) Omalizumab is recommended in patients with severe uncontrolled allergic asthma with serum IgE levels above 30 IU. 4) Anti-interleukin (IL)-5 drugs are recommended in patients with severe uncontrolled eosinophilic asthma (cut-off values above 150 cells·µL ^-1 for mepolizumab and above 400 cells·µL ^-1 for reslizumab). 5) Benralizumab is recommended in adult patients with severe uncontrolled eosinophilic asthma (cut-off values above 300 cells·µL ^-1 ). 6) Dupilumab is recommended in adult patients with severe uncontrolled allergic and eosinophilic asthma and in adult patients with severe corticosteroid-dependent asthma.
Competing Interests: Conflict of interest: G. García reports research grants from Novartis, GSK, Boehringer Ingelheim, AstraZeneca and Sanofi, and acting as a consultant/advisor/speaker for GSK, Astra Zeneca, Novartis and Sanofi. Conflict of interest: M. Bergna reports research grants from Novartis, GSK, Boehringer Ingelheim, Roche, AstraZeneca and Sanofi, and acting as a consultant/advisor/speaker for GSK, AstraZeneca and Novartis. Conflict of interest: J.C. Vazquez reports acting as a consultant/advisor/speaker for GSK, AstraZeneca, Novartis and Boehringer Ingelheim. Conflict of interest: M.C. Cano Salas reports acting as a consultant/advisor/speaker for GSK, AstraZeneca, Novartis and Boehringer Ingelheim. Conflict of interest: J.L. Miguel reports acting as a consultant/advisor/speaker for GSK, AstraZeneca, Novartis and Boehringer Ingelheim. Conflict of interest: C. Celis Preciado reports research grants from Novartis and AstraZeneca. Conflict of interest: A. Acuña Izcaray reports acting as a consultant/advisor/speaker for GSK, AstraZeneca, Novartis and Boehringer Ingelheim. Conflict of interest: M. Barros Monge reports research grants from Novartis, GSK, Boehringer Ingelheim and AstraZeneca, and acting as a consultant/advisor/speaker for GSK, AstraZeneca and Novartis. Conflict of interest: N. Garcia Batista reports acting as a consultant/advisor/speaker for AstraZeneca and Novartis. Conflict of interest: I. Zabert has nothing to disclose. Conflict of interest: J.L. Mayorga has nothing to disclose. Conflict of interest: R. Casanova Mendoza has nothing to disclose. Conflict of interest: M. Gutierrez has nothing to disclose. Conflict of interest: M.F. Montero Arias reports research grants from Novartis. Conflict of interest: L. Utrecho Perez has nothing to disclose. Conflict of interest: M. Antunez reports acting as a consultant/advisor/speaker for GSK, AstraZeneca, Novartis and Boehringer Ingelheim. Conflict of interest: V. Williams Derby has nothing to disclose. Conflict of interest: A. Villatoro Azméquita has nothing to disclose. Conflict of interest: L. Motiño has nothing to disclose. Conflict of interest: M.A. De Oliveira has nothing to disclose. Conflict of interest: D. Rey Sanchez has nothing to disclose. Conflict of interest: M. Arroyo has nothing to disclose. Conflict of interest: M. Rodriguez has nothing to disclose.
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