MEDIX, God. 27 Br. 149  •  Pregledni članak  •  Alergologija i klinička imunologija HR ENG

Teško liječiva astma i teška astmaDifficult-to-treat asthma and severe asthma

Sanja Popović-Grle

Razlikovanje teško liječive i teške astme bitno je, jer njih čine različite skupine bolesnika. Smatra se da bolesnika s teško liječivom astmom ima 17%, a bolesnika s teškom astmom 3,7%. Za osobe s teško liječivom astmom može se pokušati postići poboljšanje kontrole astme optimizacijom liječenja astme prema preferencijama bolesnika, podizanjem adherencije, procjenjujući bolesnikovu sposobnost inhaliranja lijeka i izdavanjem akcijskoga plana za astmu. Bolesnicima nedostaje edukacija i treba ih uputiti na plućnu rehabilitaciju. Osobe s teškom astmom treba uputiti u centre koji se bave teškom astmom, gdje će im provesti fenotipizaciju. Bolesnici s teškom astmom i upalom tipa 2 imaju indikaciju za dodatak biološke terapije (anti IgE, anti IL-5 ili anti IL-4/IL-13). Odabir bioloških lijekova osniva se na brižljivoj anamnezi, uključujući komorbiditete, podrobnim pretragama, a potom na multidisciplinarnoj odluci individualnom analizom bolesnika. Cilj liječenja bolesnika s teškom astmom jest maksimalno ublažiti simptome, time i socijalne i financijske posljedice bolesti za osobu i društvo.

Ključne riječi:
antiastmatički lijekovi; astma; biološka terapija; diferencijalna dijagnoza

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 27 Br. 149

The distinction between difficult-to-treat asthma and severe asthma is particularly significant because they represent different groups of patients. It is estimated that there are 17% of patients with difficult-to-treat asthma and 3.7% of patients with severe asthma. For people with difficult-to-treat asthma, attempts can be made to improve asthma control by optimizing asthma treatment according to patient preferences, raising adherence, assessing the patient’s ability to inhale the drug, and issuing an Asthma Action Plan. Patients lack education and should be referred for pulmonary rehabilitation. People with severe asthma should be referred to centres for severe asthma, where phenotyping will be performed. Patients with severe asthma and type 2 inflammation have an indication for the addition of biologic therapy (anti IgE, anti IL-5 or anti IL-4/IL-13). The selection of biological drugs is based on a careful history, including comorbidities, and detailed examinations, followed by a multidisciplinary decision based on the individual patient level analysis. The goal of treating patients with severe asthma is to alleviate symptoms as much as possible, and thus the social and financial consequences for the person and society.

Key words:
anti-asthmatic drugs; asthma; biological therapies; differencial diagnosis