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Re-evolution of asthma management: dilemmas and new paradigms.

Valero A1, Olaguibel J2, Delgado J3, Plaza V4, Álvarez F5, Molina J6, Mascarós E7, Quirce S8

Sección de Alergología. Servicio de Neumologia y Alergia. Hospital Clínic de Barcelona. Universitat de Barcelona, IDIBAPS, CIBER de Enfermedades Respiratorias (CIBERES), España.
2Unidad de Asma Grave. Servicio de Alergología. Complejo Hospitalario de Navarra. Pamplona and CIBER de Enfermedades Respiratorias (CIBERES).
3Unidad de Gestión Clínica de Alergología. Hospital Virgen Macarena. Sevilla.
4Servei de Pneumologia i Al·lèrgia. Hospital de la Santa Creu i Sant Pau. Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau). Universitat Autònoma de Barcelona. Barcelona, Spain
5Unidad de Asma. Unidad Médico-Quirúrgica de Enfermedades Respiratorias (UMQER). Hospital Universitario "Virgen del Rocio". Sevilla.
6CS Francia. Dirección Asistencial Oeste. Fuenlabrada. Madrid.
7Centro de Salud Fuente de San Luis. Departamento Hospital Dr Peset, Valencia, España.
8Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ) and CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain

J Investig Allergol Clin Immunol 2019; Vol. 29(1)
doi: 10.18176/jiaci.0345

Asthma is one of the most common inflammatory diseases in the world, and the main treatment goal is to achieve the best level of control for each patient. Although every patient is different, there are several clinical practice guidelines that can help physicians to manage this respiratory condition. However, the recommendations made by the different guidelines are not always identical, and new data on different management strategies are being continuously released, which can mislead both patients and physicians.
Our aim with this article is to summarize the main controversies in terms of management and treatment recommendations in asthma guidelines, revise the most recent scientific evidence published so far and pinpoint some possible solution to these dilemmas. This review, however, does not aim to issue new recommendations or to challenge evidence-based guidelines.
As a conclusion of this article, the authors considered that more tools are necessary to reach and measure optimal asthma control, to better assess the impact of asthma in patients’ lives.
In addition, it would be of utmost importance to appraise more accurately the short-term and long-term effectiveness and safety of asthma therapies, and the possibilities of successful immunomodulation.

Key words: Asthma control, Asthma management, Dilemma, Guidelines, Inhaled corticosteroids, Immunotherapy, Paradoxes, Treatment