American Thoracic Society Quick-Reference GUIDELINES Apps
Issue link: https://eguideline.guidelinecentral.com/i/592884
7 Remarks Adults and children aged ≥6 years with severe asthma who are considered for a trial of omalizumab should have confirmed IgE-dependent allergic asthma uncontrolled despite optimal pharmacological and non-pharmacological management and appropriate allergen avoidance if their total serum IgE level is 30–700 IU/mL (in three studies the range was wider: 30–1300 IU/mL). Treatment response should be globally assessed by the treating physician taking into consideration any improvement in asthma control, reduction in exacerbations and unscheduled healthcare utilization, and improvement in quality of life. If a patient does not respond within 4 months of initiating treatment, it is unlikely that further administration of omalizumab will be beneficial. Evidence from randomised trials is available only for adults. Because of the probable adverse effects of methotrexate and need for monitoring therapy, the ATS and ERS suggest that any use of methotrexate is limited to specialised centres and only in patients who require daily oral corticosteroids (OCS). If a decision to use methotrexate is made chest radiography, complete blood count with differential and platelets, liver function tests, serum creatinine and transfer factor of the lung for carbon monoxide (DLCO) are recommended prior to and aer commencing therapy. is recommendation applies only to the treatment of asthma. It does not apply to the use of macrolide antibiotics for other indications — e.g., treatment of bronchitis, sinusitis or other bacterial infections as indicated. In children, the evidence is limited to isolated case reports. Children should be treated with antifungals only aer the most detailed evaluation in a specialist severe asthma referral centre. As antifungal therapies are associated with significant and sometimes severe side-effects, including hepatotoxicity, clinicians should be familiar with these drugs and follow relevant precautions in monitoring for these side-effects, observing the limits to the duration of treatment recommended for each. e recommendation not to use antifungal agents in patients with severe asthma without confirmed ABPA applies only to the treatment of asthma. It does not apply to the use of antifungal agents for other indications — e.g., treatment of invasive fungal infections. is is a strong recommendation because of the very low confidence in the currently available estimates of effects of bronchial thermoplasty in patients with severe asthma. Both potential benefits and harms may be large and the long-term consequences of this new approach to asthma therapy utilizing an invasive physical intervention are unknown. Specifically designed studies are needed to define its effects on relevant objective primary outcomes, such as exacerbation rates, and on long-term effects on lung function. Studies are also needed to better understand the phenotypes of responding patients, its effects in patients with severe obstructive asthma (FEV1 <60% of predicted value) or in whom systemic corticosteroids are used, and its long-term benefits and safety. Further research is likely to have an important impact on this recommendation.