American Thoracic Society Quick-Reference GUIDELINES Apps
Issue link: https://eguideline.guidelinecentral.com/i/592884
6 Treatment Table 6. Recommended Therapies Context Recommendation Values and preferences Anti-IgE antibody (omalizumab) In patients with severe allergic asthma the ATS and ERS suggest a therapeutic trial of omalizumab both in adults and in children. (Conditional recommendation/ Low quality of evidence – adults; Very low quality of evidence – children) is recommendation places higher value on the clinical benefits from omalizumab in some patients with severe allergic asthma and lower value on increased resource use. Methotrexate e ATS and ERS suggest that clinicians do NOT use methotrexate in adults or children with severe asthma. (Conditional recommendation/Low quality of evidence) is recommendation places a relatively higher value on avoiding adverse effects of methotrexate and a relatively lower value on possible benefits from reducing the dose of systemic corticosteroids. Macrolide antibiotics e ATS and ERS suggest that clinicians do NOT use macrolide antibiotics for the treatment of severe asthma in adults and children with asthma. (Conditional recommendation/ Very low quality of evidence) is recommendation places a relatively higher value on prevention of development of resistance to macrolide antibiotics, and relatively lower value on uncertain clinical benefits. Antifungal agents e ATS and ERS suggest antifungal agents in adults with severe asthma and recurrent exacerbations of allergic bronchopulmonary aspergillosis (ABPA). (Conditional recommendation/Very low quality of evidence) e recommendation to use antifungal agents in patients with severe asthma and ABPA places a higher value on possible reduction of the risk of exacerbations and improved symptoms and a lower value on avoiding possible adverse effects, drug interactions and increased use of resources. e ATS and ERS suggest that clinicians do NOT use antifungal agents for the treatment of asthma in adults and children with severe asthma without ABPA irrespective of sensitisation to fungi (i.e. positive skin prick test or fungus-specific IgE in serum). (Conditional recommendation/ Very low quality of evidence) e recommendation not to use antifungal agents in patients with severe asthma without confirmed ABPA (irrespective of sensitisation) places a higher value on avoiding possible adverse effects, interactions of antifungal agents with other medications and increased use of resources, and a lower value on uncertain possible benefits. Bronchial ermoplasty e ATS recommends that bronchial thermoplasty be performed in adults with severe asthma only in the context of an Institutional Review Board approved independent systematic registry or a clinical study. (Strong recommendation/Very low quality of evidence) is recommendation places a higher value on avoiding adverse effects, on an 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.