Newly Introduced Agents
The therapeutic options evaluated in this context were the use of anti-IgE therapy, the use of macrolide therapy, the role of antifungal treatments and the newer treatment of bronchial thermoplasty, which are treatments that have been introduced and considered for the treatment of severe asthma. The recommendations based on analysis of available studies until September 2013 are summarized below and more comments regarding these are provided in Table 1.
Anti-IgE Therapy
A therapeutic trial of omalizumab both in adults and in children is recommended based on the clinical benefits from omalizumab in some patients with severe allergic asthma and lower value on increased resource use.
Macrolide Antibiotics
Clinicians are recommended not to use macrolide antibiotics in adults with severe asthma for the treatment of asthma based on the higher value on prevention of development of resistance to macrolide antibiotics, and relatively lower value on uncertain clinical benefits.
Antifungal Agents
The recommendation is that antifungal agents is used in adults with severe asthma and recurrent exacerbations of allergic bronchopulmonary aspergillosis (ABPA), but that antifungal agents are not used for the treatment of asthma in adults with severe asthma without ABPA, irrespective of sensitization to fungi (i.e. positive skin prick test or fungus-specific IgE in serum).
Bronchial Thermoplasty
It is recommended that bronchial thermoplasty is performed in adults with severe asthma only in the context of an Institutional Review Board-approved independent systematic registry or a clinical study. This recommendation was based on avoiding adverse effects and on increased use of resources, and on a lack of understanding of which patients may benefit, and a lower value on the uncertain improvement in symptoms and quality of life.