Expert opinion on diagnosis and management of Severe Asthma in low and middle income countries (LMIC) with focus on India

被引:0
作者
Dhar, Raja [1 ]
Talwar, Deepak [2 ]
Christopher, Devasahayam J. [3 ]
Dumra, Harjit [4 ]
Koul, Parvaiz A. [5 ]
Chhajed, Prashant N. [6 ,7 ]
Chowdhury, Sushmita Roy [8 ]
Arjun, Padmanabhan [9 ]
Guleria, Randeep [10 ,11 ]
机构
[1] CK BIRLA Hosp, Dept Pulmonol, Kolkata, India
[2] Metro Resp Ctr, Noida, India
[3] Christian Med Coll & Hosp, Dept Pulm Med, Vellore, India
[4] Sparsh Chest Dis Ctr, Ahmadabad, India
[5] Sherikashmir Inst Med Sci, Dept Pulm Med, Srinagar, Jammu & Kashmir, India
[6] Fortis Hiranandani Hosp, Inst Pulmonol Med Res & Dev, Dept Lung Care & Sleep Ctr, Mumbai, India
[7] Dr Balabhai Nanavati Hosp & Lilavati Hosp, Dept Resp Med, Mumbai, Maharashtra, India
[8] Apollo Gleneagles Hosp, Kolkata, India
[9] Kerala Inst Med Sci, Dept Resp Med, Thiruvananthapuram, Kerala, India
[10] All India Inst Med Sci AIIMS, Dept Pulm Crit Care & Sleep Med, New Delhi, India
[11] Dept Internal Med Resp & Sleep Med, Gurugram, India
关键词
Severe asthma; phenotypes; anti-IgE; anti-IL5; anti-IL4; India; LMIC; DOUBLE-BLIND; EOSINOPHILIC ASTHMA; UNCONTROLLED ASTHMA; EXACERBATIONS; MEPOLIZUMAB; BURDEN; ADULTS; AZITHROMYCIN; PHENOTYPES; PERIOSTIN;
D O I
10.1080/02770903.2024.2349614
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
ObjectiveIn this document, 9 Indian experts have evaluated the factors specific to LMICs when it came to Severe Asthma (SA) diagnosis, evaluation, biologic selection, non-biologic treatment options, and follow-up.Data sourcesA search was performed using 50 keywords, focusing on the Indian/LMICs perspective, in PubMed, Cochrane Library, and Google Scholar. The key areas of the search were focused on diagnosis, phenoendotyping, non-biological therapies, selecting a biologic, assessment of treatment response, and management of exacerbation.Study selectionsThe initial search revealed 1826 articles, from these case reports, observational studies, cohort studies, non-English language papers, etc., were excluded and we short-listed 20 articles for each area. Five relevant articles were selected by the experts for review.ResultsIn LMICs, SA patients may be referred to the specialist for evaluation a little late for Phenoendotyping of SA. While biologic therapy is now a standard of care, pulmonologists in LMICs may not have access to all the investigations to phenoendotype SA patients like fractional exhaled nitric oxide (FeNO), skin prick test (SPT), etc., but phenotyping of SA patients can also be done with simple blood investigations, eosinophil count and serum immunoglobulin E (IgE). Choosing a biologic in the overlapping phenotype of SA and ACO patients is also a challenge in the LMICs.ConclusionsGiven the limitations of LMIC, it is important to select the right patient and explain the potential benefits of biological therapy. Non-biologic add-on therapies can be attempted in a resource-limited setting where biological therapy is not available/feasible for patients.
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收藏
页码:1152 / 1164
页数:13
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