Polish Society of Alergology statement on the diagnosis and treatment of severe, difficult-to-control bronchial asthma

Severe asthma requires at least high doses of inhaled glucocorticosteroids (ICS) in combination with a long-acting β-agonist (LABA), or systemic glucocorticosteroids (CS) for more than 50% of days/year to avoid loss of control, or asthma, which remains uncontrolled despite the treatment described above. The diagnosis of severe asthma should be confirmed in a reference center as it requires careful differential diagnosis and the exclusion of factors hindering the achievement of optimal control. Severe asthma represents a significant burden for the patient, his family and the health care system. This is due to the severity of the symptoms, drug costs, significant impairment of daily activities, quality of life and limitation in the professional work. In case of ineffectiveness of the 4th step of GINA treatment, the patient should be referred to a specialist center to consider the additional treatment, including among others anti-IgE (omalizumab), anti-IL-5 (mepolizumab, reslizumab), or antibody against the α-subunit of receptor for IL-5 (benralizumab). In case of severe asthma, intensification of therapy should in the first line include the biological therapy and not the use of systemic CS. Biological drugs are available in Poland as part of the therapeutic program for the treatment of severe asthma. In practice the therapeutic program may change with subsequent announcements of the Minister of Health and does not have to be consistent with the characteristics of the medicinal product for individual preparations. The current review presents the basic principles of differential diagnosis of severe asthma and the selection of optimal biological therapy in Polish conditions.