Trustworthy guidelines on severe asthma thanks to the ERS and ATS
Authors: G. G. Brusselle, M. Kraft
Journal: European Respiratory Journal (2013)

Implementation of the ERS/ATS guidelines on severe asthma will ultimately improve the health of our patients http://ow.ly/rgnrMAlthough severe asthma is estimated to be present in less than 10% of all asthmatics, these patients have the greatest morbidity and consume an overwhelming proportion of healthcare costs [1].There have also been challenges defining the disease in terms of severity and control, characteristics which both lead to increased morbidity and mortality.Thus, the greatest unmet need in asthma care is in the severe asthma arena, where heterogeneity with regard to clinical presentation and course has posed therapeutic challenges.The identification of clinical and molecular phenotypes, as discussed in this version of the severe asthma guidelines, moves the field forward and will ultimately lead us to more personalised therapy.These guidelines describe the definition of severe asthma and provide recommendations for an approach to diagnostics and therapeutics given the data available today.Clinical practice guidelines aim to help clinicians and healthcare professionals to make evidence-based decisions about the optimal care for patients [2].In the past decade, major progress has been made in the methodology and the science of developing guidelines [3].In contrast to narrative reviews or expert consensus-based clinical position statements (also called ''strategic documents''), the development of guidelines requires that the evidence is appraised in a comprehensive and systematic manner and that the recommendations for practice are provided in a transparent manner [3,4].The Institute of Medicine has published standards for trustworthy guidelines, providing recommendations on several crucial domains in the development process including transparency, panel composition and conflict of interest [4][5][6].Importantly, funders should not play a role in the development, and guideline panels should be multidisciplinary and include patients and/or patient advocates [6,7].For the literature review and the grading of recommendations, a systematic approach is mandatory to rate the quality of the evidence, to summarise the benefits and harms of a given treatment, and to grade the strength of the recommendations [3].Since the European Respiratory Society (ERS) and American Thoracic Society (ATS) have adopted the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system for these methodological requirements, the ERS/ATS Task Force has succeeded in developing trustworthy, highquality guidelines on the definition, evaluation and treatment of severe asthma, published in this issue of the European Respiratory Journal [8].In addition, the ERS/ATS guidelines on severe asthma have many assets.A first asset of the severe asthma guidelines is a clear definition of severe asthma and uncontrolled asthma.When a diagnosis of asthma is confirmed and comorbidities addressed, severe asthma is defined as ''asthma which requires treatment with high dose inhaled corticosteroids (ICS) … plus a second controller [long acting b2-agonist (LABA), leukotriene modifier, theophylline] (and/or systemic corticosteroids) to prevent it from becoming 'uncontrolled' or which remains 'uncontrolled' despite this therapy''.The updated