Approach to patients with severe asthma: A consensus statement from the respiratory care experts� input forum (RC-EIF), Iran

Challenges in the assessment, diagnosis and management of severe, difficult-to-control asthma are increasingly regarded as
clinical needs yet unmet. The assessments required to determine asthma severity, comorbidities and confounding factors,
disease phenotypes and optimal treatment are among the controversial issues in the field.
The respiratory care experts’ input forum (RC-EIF), comprised of an Iranian panel of experts, reviewed the definition,
appraised the available guidelines and provided a consensus for evaluation and treatment of severe asthma in adults.
A systematic literature review followed by discussions during and after the forum, yielded the present consensus. The expert
panel used the appraisal of guidelines for research and evaluation-II (AGREE-II) protocol to define an initial locally-adapted
strategy for the management of severe asthma.
Severe asthma is considered a heterogeneous condition with various phenotypes. Issues such as assessment of difficult-tocontrol
asthma, phenotyping, the use of blood and sputum eosinophil count, exhaled nitric oxide to guide therapy, the
position of anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty as well as
the use of established, recently-developed and evolving treatment approaches were discussed and unanimously agreed upon
in the panel.
A systematic approach is required to ensure proper diagnosis, evaluate compliance, and to identify comorbidities and
triggering factors in severe asthma. Phenotyping helps select optimized treatment. The treatment approach laid down by the
Global Initiative for Asthma (GINA) needs to be followed, while the benefit of using biological therapies should be weighed
against the cost and safety concerns.