Severe Asthma in Adults: Pathology to Clinical Aspects

  • Kazuyuki Chibana
  • Sally Wenzel
Part of the Allergy Frontiers book series (ALLERGY, volume 3)


Severe asthma consists of a group of patients with frequent and high intensity health care utilization, despite treatment with high dose corticosteroids, long-acting beta agonists and/or leukotriene modifiers. Severe asthma likely afflicts less than 10% of asthma population and represents a heterogeneous group of patients. Risk factors for severe asthma include both genetic and environmental factors, with allergen exposure, cigarette smoke and viral infection all recognized environmental risk factors. Genetic risk factors are less clear, although polymorphisms in Th2 pathway elements have been implicated to date. Pathologically, severe asthma can be divided into eosinophilic or non-eosinophilic phenotypes, with the eosinophilic phenotype related to increases in exacerbations and associated remodeling of the subepithelial basement menbrane. Neutrophilic inflammation may also be seen in severe asthma, often in association with lower lung function. Important things for evaluation of severe asthma are confirmation that the disease is asthma, evaluation excerbating factor and phenotype. The evaluation of severe asthma includes confirming that the disease is, in fact asthma and then determining which phenotype of severe asthma the patient may have. Treatment of severe asthma then should be targeted to the clinical, immunologic and inflammatory phenotype.


Severe Asthma Allergy Clin Immunol Respir Crit Vocal Cord Dysfunction Eosinophilic Asthma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer 2009

Authors and Affiliations

  • Kazuyuki Chibana
    • 1
  • Sally Wenzel
    • 1
  1. 1.Division of Pulmonary, Allergy and Critical Care MedicineUniversity of PittsburgPittsburgUSA

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