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Dilemmas and New Paradigms in Asthma Management

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

1Sección de Alergología, Servicio de Neumología y Alergia, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, CIBER de Enfermedades Respiratorias (CIBERES), Spain
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, Spain
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, Spain
6CS Francia, Dirección Asistencial Oeste, Fuenlabrada, Madrid, Spain
7Centro de Salud Fuente de San Luis, Departamento Hospital Dr Peset, Valencia, Spain
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) : 15-23
doi: 10.18176/jiaci.0345

Asthma is one of the most common inflammatory diseases in the world. The main goal of treatment is to achieve optimal control. Although every patient is different, clinical practice guidelines can help physicians to manage the disease. However, the recommendations made by guidelines are not always identical, and the continuous release of new data on the various management strategies can mislead both patients and physicians.
We aim to summarize the main controversies in management and treatment recommendations in asthma guidelines, revise the most recent scientific evidence, and pinpoint possible solutions. We do not issue new recommendations or challenge evidence-based guidelines. We concluded that more tools are necessary to achieve and measure optimal asthma control and to better assess the impact of asthma on patients’ lives. Also essential is a more accurate appraisal of 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