Immunomodulatory and biologic therapies for severe refractory asthma

Despite undoubted efficacy of the combination of inhaled corticosteroids and beta(2)-agonists for most asthmatic patients with mode rate-to-severe disease, there remains similar to 10% of the asthmatic population with serious unremitting symptoms, resulting in considerable impact on quality of life, disproportionate use of health care resources, and adverse effects from regular systemic steroid use. In an ideal. world, optimal treatment of severe refractory asthma should achieve the best possible asthma control and quality of life with the [east dose of systemic corticosteroids. The choice and formulation of therapeutic agent are dictated by the severity of disease and may include immunological modifiers and biologic therapies. Unfortunately, current asthma guidelines offer little contribution to the management of the challenging patient with severe refractory asthma and none of them have addressed therapeutic alternatives to oral corticosteroids. This article reviews the current evidence for immunomodulating and biologic approaches in severe refractory asthma. (C) 2008 Elsevier Ltd. All rights reserved.