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Review
. 2013 Dec;68(12):1520-31.
doi: 10.1111/all.12275. Epub 2013 Nov 6.

EAACI position statement on asthma exacerbations and severe asthma

A Custovic  1 , S L Johnston, I Pavord, M Gaga, L Fabbri, E H Bel, P Le Souëf, J Lötvall, P Demoly, C A Akdis, D Ryan, M J Mäkelä, F Martinez, J W Holloway, S Saglani, P O'Byrne, A Papi, S Sergejeva, A Magnan, S Del Giacco, O Kalayci, E Hamelmann, N G Papadopoulos
Affiliations
Review

EAACI position statement on asthma exacerbations and severe asthma

A Custovic et al. Allergy. 2013 Dec.

Abstract

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.

Keywords: adult asthma; asthma exacerbations; childhood asthma; disease heterogeneity; severe asthma.

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Conflict of interest statement

A. Custovic serves as a consultant for Circassia. He received speaker fees from Glaxo Smith Kline, Thermo Fisher Scientific, Airsonet, Novartis, MSD and ALK. He received research grants from the UK Medical Research Council, Moulton Charitable foundation National Institute of Health Research.

In the past five years S. L. Johnston has had research grants from Astra Zeneca, Centocor, GlaxoSmithKline, MedImmune, Sanofi‐Pasteur and Synairgen. S. L. Johnston holds share options in Synairgen. S. L. Johnston does some consultancy work for AstraZeneca, Centocor, GlaxoSmithKline, MedImmune, Sanofi‐Pasteur and Synairgen.

In the last five years, I. D. Pavord has received speaker's honoraria for speaking at sponsored meetings from Astra Zeneca, Boehringer Inglehiem, Aerocrine and GSK. He has received honoraria for attending advisory panels with Almirall, Astra Zeneca, Boehringer Ingelheim, GSK, MSD, Schering‐Plough, Novartis, Dey and Napp. He has received sponsorship to attend international scientific meetings from Boehringer Ingelheim, GSK, Astra Zeneca and Napp.

M. Gaga received research grants from Novartis, BI, Cephalon, Teva and GSK.

L. M. Fabbri has received consultancy fees from: Boehringer Ingelheim, Chiesi, GlaxoSmithKline, MSD, Nycomed, Pearl Therapeutics, Sterna, Peer Voice Europe, OM Pharma Sa, Kyorin Pharmaceutical, Boston Scientific and Bayer. Readings, advisory board or reimbursement of expenses: AstraZeneca, Novartis, Sigma‐Tau, Roche, Deutsches Zentrum für Luft und Raumfahrt, German Aerospace Center, Mundipharma Int., Genetech Inc., Elevation Pharmaceutical, Ferrer Group, Nycomed, Dynamicon and Laboratori Guidotti.

E. Bel has received consultancy fees from Novartis, GSK and Sanofi‐Regeneron, and fees for speaking from GSK.

P. Le Souëf has received speaker fees from Glaxo Smith Kline and AstraZeneca and has received research funding from AstraZeneca and Pharmanet AG. He has received research grants from the National Health and Medical Research Council of Australia and the Australian Research Council.

J. Lötvall has over the last five years been a consultant and/or given lectures for GSK, AstraZeneca, Aerovant, Novartis, UCB, Oriel and Merck, for which he has received honoraria. He has also received research grants and participated in clinical trials for Novartis, GSK, AstraZeneca and Actelion under the full organization of the University of Gothenburg.

P. Demoly is a consultant and a speaker for Stallergenes, ALK, Circassia and Chiesi and is a speaker for Merck, AstraZeneca, Menarini and GlaxoSmithKline.

C. Akdis serves in the scientific advisory boards of Novartis, Actellion, Circassia, Allergopharma and Stallergenes. He received research grants from Novartis, Swiss National Science Foundation, Swiss‐Polish Research Grant.

D. Ryan has been supported to attend conferences, provide consultancy services to or lectured on behalf of AZ, Novartis, Chiesi, Mundipharma, MSD and Aerocrine.

Mika Mäkelä has received speaker fees from Berlin‐Chemie Menarini, GlaxoSmithKline, MSD and Orion Pharma. He serves as a consultant for Orion Pharma. He received research grant from Sigrid Juselius Foundation and Helsinki University Hospital Research Grant.

F. D. Martinez served as a consultant to MedImmune in 2010. He received speaker fees from Merck in 2011 and from Abbott in 2011 and 2012. He receives grant funds from the National Institutes of Health.

P. O'Byrne serves in the scientific advisory boards of Abbott, AstraZeneca, Asmacure, Boehringer Ingelheim, GlaxoSmithKline and Medimmune Merck. He received speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline and Nycomed, and also he received grants from AIM, Amgen, AstraZeneca, Genentech, GlaxoSmithKline, Novartis and ONO.

A. Papi has been on scientific advisory boards and received speaker fees from AstraZeneca, Chiesi, GlaxoSmithKline, Teva, Mundipharma, Novartis, BI, Almirall and Menarini. He received research grants from AstraZeneca, Chiesi, GlaxoSmithKline, Novartis, BI and the University of Ferrara.

A. Magnan serves as a consultant for Novartis, Takeda Mundipharma and Boehringer. He received speaker fees from Glaxo Smith Kline, Chiesi, Novartis, MSD and Mundipharma. He received research grants from MSD.

E. Hamelmann serves as a consultant for Boehringer Ingelheim, HAL Allergy, ALK and Novartis. He received speaker fees from Stallergenes, Symbiopharm, Novartis and ALK. He received research grants from the German National Research Foundation (DFG), the German Ministry for Education and Research (BMBF), and the Ministry for Education and Research of Nordrhein‐Westfalen.

N. G. Papadopoulos has received payment for consultancy from AbbVie, Novartis, Menarini, MEDA for lectures from Novartis, URIACH, GSK, ALLERGOPHARMA, Stallergens for development of educational presentations from URIACH, MEDA and grants from Nestle, MSD and GSK.

The other authors of the paper declare no conflicts of interest.

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