EAACI position statement on asthma exacerbations and severe asthma
Open accessAbstract
Asthma exacerbations and severe asthma are linked with high morbidity, significant mortality and high treatment costs. Recurrent asthma exacerbations cause a decline in lung function and, in childhood, are linked to development of persistent asthma. This position paper, from the European Academy of Allergy and Clinical Immunology, highlights the shortcomings of current treatment guidelines for patients suffering from frequent asthma exacerbations and those with difficult-to-treat asthma and severe treatment-resistant asthma. It reviews current evidence that supports a call for increased awareness of (i) the seriousness of asthma exacerbations and (ii) the need for novel treatment strategies in specific forms of severe treatment-resistant asthma. There is strong evidence linking asthma exacerbations with viral airway infection and underlying deficiencies in innate immunity and evidence of a synergism between viral infection and allergic mechanisms in increasing risk of exacerbations. Nonadherence to prescribed medication has been identified as a common clinical problem amongst adults and children with difficult-to-control asthma. Appropriate diagnosis, assessment of adherence and other potentially modifiable factors (such as passive or active smoking, ongoing allergen exposure, psychosocial factors) have to be a priority in clinical assessment of all patients with difficult-to-control asthma. Further studies with improved designs and new diagnostic tools are needed to properly characterize (i) the pathophysiology and risk of asthma exacerbations, and (ii) the clinical and pathophysiological heterogeneity of severe asthma.
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Interpretation of allergy tests has moved from dichotomization based on arbitrary criteria to quantification using specific IgE titer and skin prick test wheal size.
“This has changed the way we interpret the results of allergy tests, with a move from dichotomization (labeling patients as being sensitized based on a “positive” test using arbitrary criteria), to quantification of blood or skin tests using sIgE titer and SPT wheal size.893,1010-1012”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [1012]
In “Attempts to characterize severe asthma in childhood” (page not provided), the paper recommends quantifying skin-test and allergen-specific IgE results in children with severe treatment-resistant asthma and discusses a quantitative relationship in adults. It does not describe a general move away from dichotomizing allergy tests using arbitrary positive-test criteria. (LLM, conf=0.85)
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Risk of invasive pneumococcal infections among working age adults with asthma
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PM10-induced Hospital Admissions for Asthma and Chronic Obstructive Pulmonary Disease
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Self-citationNon-adherence in difficult asthma: time to take it seriously
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Randomized Trial of Omalizumab (Anti-IgE) for Asthma in Inner-City Children
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Risk Factors for Invasive Pneumococcal Disease in Children in the Era of Conjugate Vaccine Use
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WHO universal definition of severe asthma
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Ultrastructure of the reticular basement membrane in asthmatic adults, children and infants
Saglani, S., Molyneux, C., Gong, H., Rogers, A. V., Malmström, K., Pelkonen, A. S., Mäkelä, M. J., Adelroth, E. C., Bush, A., Payne, D., et al. (2006) · European Respiratory Journal · doi:10.1183/09031936.06.00056405 · Cited by 71 · see citing works
Self-citationAgainst all odds: anti-IgE for intrinsic asthma?
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Self-citationBronchial Thermoplasty for Severe Asthma
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Long-term effectiveness of a staged assessment for paediatric problematic severe asthma
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Pediatric asthma and development of atopy
Custovic, A., Lazic, N., & Simpson, A. (2013) · Current Opinion in Allergy & Clinical Immunology · doi:10.1097/aci.0b013e32835e82b6 · Cited by 53 · see citing works
Self-citationBehavior Problems Antecede the Development of Wheeze in Childhood
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A centralised respiratory diagnostic service for primary care: a 4-year audit
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Definitions of asthma exacerbations
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True adherence with the Turbuhaler in young children with asthma
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Self-citationUrbanisation, asthma and allergies
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Anti-IgE for Asthma in Inner-City Children
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Flagged first, then by citations
Research works printed but not linked: 3
- Loymans RJ, Ter Riet G, Sterk PJ. Defini- tions of asthma exacerbations. Curr Opin Allergy Clin Immunol 2011;11:181-186.
- John Wiley & Sons A/S. Published by John Wiley & Sons Ltd corticosteroids for persistent asthma. J Allergy Clin Immunol 2002;109:410-418.
- Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW, Lundberg JO et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med 2011;184:602-615.
Cited by
Sorted by citations
International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis
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“Swedish recommendations on asthma management are similar to the GINA guidelines [2], in which it is recommended that severe asthma should be managed by respiratory/allergy specialists [2, 5, 9].”
BackgroundMethodDel Giacco, S. R., Cappai, A., Gambula, L., Cabras, S., Perra, S., Manconi, P. E., Carpiniello, B., & Pinna, F. (2016) · Respiratory Medicine · doi:10.1016/j.rmed.2016.09.014 · Cited by 85 · see citing works
Impact of rhinitis on asthma severity in school-age children
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Self-citation
- Authors
- Custovic, A., Johnston, S. L., Pavord, I., Gaga, M., Fabbri, L., Bel, E. H., Le Souëf, P., Lötvall, J., Demoly, P., Akdis, C. A., Ryan, D., Mäkelä, M. J., Martinez, F., Holloway, J. W., Saglani, S., O'Byrne, P., Papi, A., Sergejeva, S., Magnan, A., Del Giacco, S., Kalayci, O., Hamelmann, E., & Papadopoulos, N. G.
- Affiliations
- Centre Lead for Respiratory Medicine; Institute of Inflammation & Repair; University of Manchester; University Hospital of South Manchester; Manchester UK
- Imperial College London (GB)
- Glenfield Hospital (GB)
- 7th Respiratory Medicine Department and Asthma Centre; Athens Chest Hospital; Athens Greece
- University of Modena and Reggio Emilia (IT)
- Amsterdam UMC Location University of Amsterdam (NL)
- Department of Respiratory Medicine; University of Western Australia; Princess Margaret Hospital for Children; Perth WA Australia
- University of Gothenburg (SE)
- Inserm (FR)
- Swiss Institute of Allergy & Asthma Research (SIAF); University of Zurich; Davos
- Loughborough Hospital (GB)
- Helsinki University Hospital (FI)
- University of Arizona; Arizona Health Sciences Center; Pediatric Pulmonary Center; Tucson AZ USA
- Southampton General Hospital (GB)
- Department of Medicine; Michael G DeGroote School of Medicine; McMaster University Faculty of Health Sciences; Hamilton ON Canada
- University of Ferrara (IT)
- University of Tartu (EE)
- Department of Medical Science; University of Cagliari; Cagliari Italy
- Pediatric Allergy and Asthma Unit; Ihsan Dogramaci Children's Hospital; Hacettepe University School of Medicine; Ankara Turkey
- Stiftung Charité (DE)
- National and Kapodistrian University of Athens (GR)
- ORCID
- Venue
- Allergy
- Publisher
- Wiley
- Published
- 2013-11-06
- Volume
- 68
- Issue
- 12
- Pages
- 1520-1531
- ISSN
- 0105-4538 (ISSN-L)
- PMC
- PMC7159478
- OpenAlex
- W2068966334
- Cited by
- 127
- References
- 116
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 11 · 2022: 5 · 2021: 6 · 2020: 11 · 2019: 14 · 2018: 13 · 2017: 14 · 2016: 27 · 2015: 13 · 2014: 6 · 2013: 1
- FWCI
- 1.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Allergy (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- UNICA IRIS Institutional Research Information System (University of Cagliari) (submittedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Funders
- National Science Foundation
- Amgen
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- Teva Pharmaceutical Industries
- Boston Scientific Corporation
- Regeneron Pharmaceuticals
- Kyorin Pharmaceutical
- National Institute for Health and Care Research (NF-SI-0510-10157)
- Asthma and Lung UK (CH11SJ)
- National Research Foundation
- Deutsche Forschungsgemeinschaft
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
- Bundesministerium für Bildung und Forschung
- Deutsches Zentrum für Luft- und Raumfahrt
- Göteborgs Universitet
- Università degli Studi di Ferrara
- European Academy of Allergy and Clinical Immunology
- National Institutes of Health
- Genentech
- Allergopharma
- Pearl Therapeutics
- Medical Research Council
- Australian Research Council
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- asthma exacerbations, severe asthma, treatment-resistant asthma, difficult-to-treat asthma, innate immunity, medication non-adherence, smoking, allergen exposure, psychosocial factors, persistent asthma, asthma treatment guidelines, lung function decline
- MeSH terms
- Animals, Asthma, Humans, Severity of Illness Index, Practice Guidelines as Topic, Disease Progression
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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