Severe Asthma ToolkitSevere Asthma Toolkit
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  • What is Severe Asthma?
    • Overview
    • Definition
    • Prevalence & Burden
    • Pathophysiology
    • Symptoms
    • Severe Asthma Attacks / Exacerbations / Flare-ups
    • Asthma Phenotypes
  • Diagnosis & Assessment
    • Overview
    • Diagnosis Overview
    • Assessment Overview
    • Lung Function Assessments
    • Questionnaires
    • Allergy Assessments
    • Phenotyping
    • Bronchoscopy
    • Imaging
    • Occupational Asthma
  • Management
    • Overview
    • Asthma Education
      • About Severe Asthma
      • Asthma Pathophysiology
      • Medications Education
      • Self-Monitoring
      • Triggers
      • Review
    • Written Action Plans
    • Adherence
    • Inhaler Technique
    • Physical Activity & Exercise
    • Interdisciplinary Approach & Multidimensional Assessment
    • Referral
  • Medications
    • Overview
    • Relievers
    • Preventers / Controllers
    • Add-on Therapies
    • Monoclonal Antibodies
      • Travelling with Monoclonal Antibodies
    • Bronchial Thermoplasty
  • Co-Morbidities
    • Overview
    • Pulmonary & Upper Airways
      • Allergic & Non-Allergic Rhinitis
      • Chronic Rhinosinusitis
      • Dysfunctional Breathing
      • Vocal Cord Dysfunction
      • Chronic Obstructive Pulmonary Disease
      • Bronchiectasis
      • Obstructive Sleep Apnoea
    • Extra-Pulmonary
      • Obesity
      • Anxiety & Depression
      • Gastro-oesophageal Reflux Disease (GORD)
      • Osteoporosis
      • Cardiovascular Disease & Metabolic Disease
  • Living with Severe Asthma
    • Overview
    • Daily Symptom Burden
    • Mental & Emotional Health
    • Intimacy & Relationships
    • Self-Management Support
    • Medication Use & Costs
    • Experience of Care
    • Experience of Asthma Attacks
    • Prognosis
  • Establishing a Clinic
    • Overview
    • Set-up
    • Staffing & Multidisciplinary Team Approach
    • Facilities
    • Delivery Approach
    • Tailored Referrals
    • Evaluation
    • Opportunities for Training & Research
    • Barriers & Hurdles
  • Paediatrics
    • Overview
    • Management in Paediatrics
    • Assessment in Paediatrics
    • Alternative Diagnosis & Co-Morbidities in Paediatrics
    • Psychosocial Issues in Paediatrics
    • Medications in Paediatrics
    • Asthma in the Adolescent Population
  • Resources
    • Overview
    • Clinic Recommendations
    • Infographics
    • Asthma Assessment Resources
    • Systematic & Multidimensional Assessment Resources
      • Airway Components
      • Comorbidity Components
      • Risk Factor Components
    • Translation & Implementation
    • Case Studies
    • Presentations
    • Videos
    • Relevant Links
    • Key References

Overview

Home Medications Overview

When a diagnosis of severe, treatment refractory asthma has been confirmed, treatment emphasis shifts from a stepped approach to a targeted approach for treatment.

A severe asthma assessment is needed to confirm diagnosis, optimise skills and manage risk factors and comorbidities.

Referral to tertiary care and potentially a severe asthma clinic is often appropriate and necessary, for the integration of add-on therapies into management.

Therapeutic trials of add-on therapies (e.g. tiotropium, anti-fungal agents, montelukast, low dose macrolide antibiotics) may be undertaken for defined periods of time, but clinicians should be prepared to cease these medications if there is no clear sign of benefit. For more information see Add-on Therapies & Monoclonal Antibodies.

Relievers

Preventers / Controllers

Add-on Therapies

Monoclonal Antibodies

Bronchial Thermoplasty

Key Points

  • Regular use of inhaled corticosteroids and long acting bronchodilators and correct inhaler technique are the basis of treatment.
  • All patients should be assessed for modifiable psychosocial, behavioural and medical problems that may be contributing to symptoms, prior to consideration of add-on therapies.
  • Biologicals (monoclonal antibodies) target specific inflammatory pathways, and in appropriately selected severe asthma patients can have a major impact on asthma exacerbations, asthma control and quality of life.
  • Phenotyping is needed to select the right add-on therapy for the right person.
  • Monoclonal antibodies are now available in Australia for the treatment of severe allergic asthma and severe eosinophilic asthma. Additional monoclonal antibodies are likely to become available in the next few years.
  • Long term use of oral corticosteroids should be minimised where possible.
  • Add-on therapies should be withdrawn if there is no evidence of benefit after a defined period of time.
Read more
Click here to download a printable version of the infographic below.

Access the full suite of infographics here.

severe asthma medication infographic

Last Updated on September 19, 2019

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  • Overview
  • Relievers
  • Preventers / Controllers
  • Add-on Therapies
  • Monoclonal Antibodies
    • Travelling with Monoclonal Antibodies
  • Bronchial Thermoplasty
For considerations relevant to the paediatric and adolescent population, please see Medications in Paediatrics

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