| چکیده انگلیسی مقاله |
Challenges in the assessment, diagnosis and management of severe, difficult-to-control asthma are increasingly regarded as clinical needs yet unmet. The assessments required to determine asthma severity, comorbidities and confounding factors, disease phenotypes and optimal treatment are among the controversial issues in the field. The respiratory care experts’ input forum (RC-EIF), comprised of an Iranian panel of experts, reviewed the definition, appraised the available guidelines and provided a consensus for evaluation and treatment of severe asthma in adults. A systematic literature review followed by discussions during and after the forum, yielded the present consensus. The expert panel used the appraisal of guidelines for research and evaluation-II (AGREE-II) protocol to define an initial locally-adapted strategy for the management of severe asthma. Severe asthma is considered a heterogeneous condition with various phenotypes. Issues such as assessment of difficult-tocontrol asthma, phenotyping, the use of blood and sputum eosinophil count, exhaled nitric oxide to guide therapy, the position of anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty as well as the use of established, recently-developed and evolving treatment approaches were discussed and unanimously agreed upon in the panel. A systematic approach is required to ensure proper diagnosis, evaluate compliance, and to identify comorbidities and triggering factors in severe asthma. Phenotyping helps select optimized treatment. The treatment approach laid down by the Global Initiative for Asthma (GINA) needs to be followed, while the benefit of using biological therapies should be weighed against the cost and safety concerns. |
| نویسندگان مقاله |
Khalil Ansarin |
Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,
Davood Attaran |
Lung Disease Research Center, Mashhad University of Medical Science,
Mashhad, Iran,
Hamidreza Jamaati |
Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences,
Tehran, Iran,
Mohammad Reza Masjedi |
Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences,
Tehran, Iran,
Hamidreza Abtahi |
Advanced Thoracic Research Center, Pulmonary and Critical Care Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran,
Ali Alavi |
Department of Pulmonology, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran,
Masoud Aliyali |
Department of Internal Medicine, Pulmonary and Critical Care Division, Mazandaran
University of Medical Sciences, Sari, Iran,
Amir Mohammad Hashem Asnaashari |
Lung Disease Research Center, Mashhad University of Medical Science,
Mashhad, Iran,
Reza Farid-Hosseini |
Allergy Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,
Seyyed Mohammad Ali Ghayumi |
Department of Internal Medicine,
Division of Pulmonology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran,
Hassan Ghobadi |
Department of Internal Medicine, Pulmonary Division, School of Medicine, Ardabil
University of Medical Sciences, Ardabil, Iran,
Atabak Ghotb |
Behphar Scientific Committee, Behphar Group, Tehran, Iran,
Abolhassan Halvani |
Respiratory-Care Experts’ Input Forum, Mortaz Hospital, Yazd, Iran,
Abbas Nemati |
Department of Pulmonology, Artesh University of Medical Sciences, Tehran, Iran,
Masoud Rahimian |
Department of Internal medicine, Division of Pulmonary and Critical Care Medicine , Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Ramin Sami |
Department of Pulmonary Diseases, Qazvin University of Medical Sciences, Qazvin, Iran,
Hamid Sohrabpour |
Department of Pulmonary Medicine, Shahid Beheshti University of Medical Sciences,
Tehran, Iran,
Sassan Tavana |
Clinical Research & Development Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Mohammad Torabi-Nami |
Behphar Scientific Committee, Behphar Group, Tehran, Iran,
Parviz Vahedi |
Division of Pulmonology, Department of Internal Medicine, Imam Reza
Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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