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Intern Med J. 2017 Jun;47(6):623-631. doi: 10.1111/imj.13441.

Management of severe asthma: targeting the airways, comorbidities and risk factors.

Gibson PG1,2,3,4, McDonald VM1,2,3,4.

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National Health and Medical Research Council Centre of Excellence in Severe Asthma, The University of Newcastle, Newcastle, New South Wales, Australia.
Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, New South Wales, Australia.
VIVA, Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.


Severe asthma is a complex heterogeneous disease that is refractory to standard treatment and is complicated by multiple comorbidities and risk factors. In mild to moderate asthma, the burden of disease can be minimised by inhaled corticosteroids, bronchodilators and self-management education. In severe asthma, however, management is more complex. When patients with asthma continue to experience symptoms and exacerbations despite optimal management, severe refractory asthma (SRA) should be suspected and confirmed, and other aetiologies ruled out. Once a diagnosis of SRA is established, patients should undergo a systematic and multidimensional assessment to identify inflammatory endotypes, risk factors and comorbidities, with targeted and individualised management initiated. We describe a practical approach to assessment and management of patients with SRA.


comorbidity; management; severe asthma

[Indexed for MEDLINE]

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