Severe Asthma: An Update for 2019

Adam D. Highley, MD; Craig Cookman, DO; Lee E. Morrow, MD, FCCP, ATSF; Mark A. Malesker, PharmD, FCCP, FCCP, FCCM, FASHP, BCPS


US Pharmacist. 2019;44(7):HS 2-HS 7. 

In This Article

Abstract and Introduction


Asthma is a common respiratory disorder, and the presentation of patients with acute, poorly controlled asthma remains a clinical challenge. In current guidelines, severe asthma represents a subset of difficult-to-treat asthma that, despite treatment of contributing factors and patient compliance with optimized therapy, remains uncontrolled, or asthma that worsens when high-intensity therapy is decreased. Acute exacerbations are managed with inhaled bronchodilators, inhaled corticosteroids, and oral corticosteroids. Patient-specific pharmacotherapy to prevent acute exacerbations includes the use of inhaled corticosteroids plus a long-acting bronchodilator, a short-acting bronchodilator for rescue, a long-acting muscarinic, a leukotriene antagonist, and biologics.


Asthma is a chronic disorder of the airways that is characterized by variable and recurring airway inflammation and bronchial hyperresponsiveness. In this common condition that affects people in all age groups, the resulting bronchoconstriction, airway-wall edema, and excessive mucus secretion collectively lead to airway obstruction and symptoms that include some constellation of cough, wheezing, chest tightness, and dyspnea. As with any disease, asthma has a spectrum of severity. Although severe asthma occurs in 3% to 10% of the asthmatic population, the care of these patients accounts for more than 60% of the total costs attributed to asthma.[1–3] These costs, which are primarily related to medication, are higher per person than those associated with chronic obstructive pulmonary disease or type 2 diabetes.[3,4] This review will focus on the management of patients presenting with acute, poorly controlled asthma.