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Erschienen in: Zeitschrift für Pneumologie 2/2022

15.02.2022 | Asthma bronchiale | CME

Diagnostik und Therapie von Asthma bei Erwachsenen

verfasst von: Prof. Dr. Marek Lommatzsch

Erschienen in: Zeitschrift für Pneumologie | Ausgabe 2/2022

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Zusammenfassung

Ziel einer modernen Asthmatherapie ist die Prävention von Symptomen mit nebenwirkungsarmen und hochwirksamen Medikamenten im Sinne einer dauerhaften Asthma-Remission. Diesem Ziel folgen die aktuellen Behandlungskonzepte zum individuellen, phänotypspezifischen Einsatz von ICS(inhalative Steroide)-basierten inhalativen Therapien, von Biologika und von Allergenimmuntherapien. Im vorliegenden Beitrag werden die aktuellen Empfehlungen zur gezielten Diagnostik und zur phänotypspezifischen Therapie von Asthma bei Erwachsenen vor dem Hintergrund der neuen internationalen Asthmaleitlinie und der neuen Nationalen Versorgungsleitlinie Asthma (2020) dargestellt.
Literatur
1.
Zurück zum Zitat Lommatzsch M (2020) Immune modulation in asthma: current concepts and future strategies. Respiration 99(7):566–576 CrossRef Lommatzsch M (2020) Immune modulation in asthma: current concepts and future strategies. Respiration 99(7):566–576 CrossRef
2.
Zurück zum Zitat Lommatzsch M, Buhl R, Korn S (2020) The treatment of mild and moderate asthma in adults. Dtsch Arztebl Int 117(25):434–444 PubMedPubMedCentral Lommatzsch M, Buhl R, Korn S (2020) The treatment of mild and moderate asthma in adults. Dtsch Arztebl Int 117(25):434–444 PubMedPubMedCentral
4.
Zurück zum Zitat Langen U, Schmitz R, Steppuhn H (2013) Häufigkeit allergischer Erkrankungen in Deutschland. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56(5):698–706 CrossRef Langen U, Schmitz R, Steppuhn H (2013) Häufigkeit allergischer Erkrankungen in Deutschland. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56(5):698–706 CrossRef
6.
Zurück zum Zitat Pavord ID, Beasley R, Agusti A et al (2018) After asthma: redefining airways diseases. Lancet 391(10118):350–400 CrossRef Pavord ID, Beasley R, Agusti A et al (2018) After asthma: redefining airways diseases. Lancet 391(10118):350–400 CrossRef
7.
Zurück zum Zitat Lambrecht BN, Hammad H, Fahy JV (2019) The cytokines of asthma. Immunity 50(4):975–991 CrossRef Lambrecht BN, Hammad H, Fahy JV (2019) The cytokines of asthma. Immunity 50(4):975–991 CrossRef
8.
Zurück zum Zitat Lommatzsch M, Klein M, Stoll P, Virchow JC (2021) Type 2 biomarker expression (FeNO and blood eosinophils) is higher in severe adult-onset than in severe early-onset asthma. Allergy 76(10):3199–3202 CrossRef Lommatzsch M, Klein M, Stoll P, Virchow JC (2021) Type 2 biomarker expression (FeNO and blood eosinophils) is higher in severe adult-onset than in severe early-onset asthma. Allergy 76(10):3199–3202 CrossRef
9.
Zurück zum Zitat Buhl R, Bals R, Baur X et al (2017) Guideline for the diagnosis and treatment of asthma—guideline of the German respiratory society and the German Atemwegsliga in cooperation with the paediatric respiratory society and the Austrian society of pneumology. Pneumologie 71(12):849–919 CrossRef Buhl R, Bals R, Baur X et al (2017) Guideline for the diagnosis and treatment of asthma—guideline of the German respiratory society and the German Atemwegsliga in cooperation with the paediatric respiratory society and the Austrian society of pneumology. Pneumologie 71(12):849–919 CrossRef
12.
Zurück zum Zitat Henneberger PK, Patel JR, de Groene GJ et al (2019) Workplace interventions for treatment of occupational asthma. Cochrane Database Syst Rev 10:Cd6308 PubMed Henneberger PK, Patel JR, de Groene GJ et al (2019) Workplace interventions for treatment of occupational asthma. Cochrane Database Syst Rev 10:Cd6308 PubMed
13.
Zurück zum Zitat To T, Stanojevic S, Moores G et al (2012) Global asthma prevalence in adults: findings from the cross-sectional world health survey. BMC Public Health 12:204 CrossRef To T, Stanojevic S, Moores G et al (2012) Global asthma prevalence in adults: findings from the cross-sectional world health survey. BMC Public Health 12:204 CrossRef
14.
Zurück zum Zitat Lommatzsch M, Virchow JC (2012) Asthma-Diagnostik: aktuelle Konzepte und Algorithmen. Allergologie 35(9):454–467 CrossRef Lommatzsch M, Virchow JC (2012) Asthma-Diagnostik: aktuelle Konzepte und Algorithmen. Allergologie 35(9):454–467 CrossRef
15.
Zurück zum Zitat Burrows B, Martinez FD, Halonen M, Barbee RA, Cline MG (1989) Association of asthma with serum IgE levels and skin-test reactivity to allergens. N Engl J Med 320(5):271–277 CrossRef Burrows B, Martinez FD, Halonen M, Barbee RA, Cline MG (1989) Association of asthma with serum IgE levels and skin-test reactivity to allergens. N Engl J Med 320(5):271–277 CrossRef
16.
Zurück zum Zitat Lommatzsch M, Speer T, Herr C et al (2022) IgE is associated with exacerbations and lung function decline in COPD. Respir Res 23(1):1 CrossRef Lommatzsch M, Speer T, Herr C et al (2022) IgE is associated with exacerbations and lung function decline in COPD. Respir Res 23(1):1 CrossRef
17.
Zurück zum Zitat Hartl S, Breyer MK, Burghuber OC et al (2020) Blood eosinophil count in the general population: typical values and potential confounders. Eur Respir J 55(5):1901874 CrossRef Hartl S, Breyer MK, Burghuber OC et al (2020) Blood eosinophil count in the general population: typical values and potential confounders. Eur Respir J 55(5):1901874 CrossRef
19.
Zurück zum Zitat Lommatzsch M, Klein M, Stoll P, Virchow JC (2019) Impact of an increase in the inhaled corticosteroid dose on blood eosinophils in asthma. Thorax 74(4):417–418 CrossRef Lommatzsch M, Klein M, Stoll P, Virchow JC (2019) Impact of an increase in the inhaled corticosteroid dose on blood eosinophils in asthma. Thorax 74(4):417–418 CrossRef
20.
Zurück zum Zitat Price DB, Rigazio A, Campbell JD et al (2015) Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study. Lancet Respir Med 3(11):849–858 CrossRef Price DB, Rigazio A, Campbell JD et al (2015) Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study. Lancet Respir Med 3(11):849–858 CrossRef
21.
Zurück zum Zitat Busse WW, Wenzel SE, Casale TB et al (2021) Baseline FeNO as a prognostic biomarker for subsequent severe asthma exacerbations in patients with uncontrolled, moderate-to-severe asthma receiving placebo in the LIBERTY ASTHMA QUEST study: a post-hoc analysis. Lancet Respir Med 9(10):1165–1173 CrossRef Busse WW, Wenzel SE, Casale TB et al (2021) Baseline FeNO as a prognostic biomarker for subsequent severe asthma exacerbations in patients with uncontrolled, moderate-to-severe asthma receiving placebo in the LIBERTY ASTHMA QUEST study: a post-hoc analysis. Lancet Respir Med 9(10):1165–1173 CrossRef
24.
Zurück zum Zitat Dweik RA, Boggs PB, Erzurum SC et al (2011) An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med 184(5):602–615 CrossRef Dweik RA, Boggs PB, Erzurum SC et al (2011) An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med 184(5):602–615 CrossRef
25.
Zurück zum Zitat Menzies-Gow A, Bafadhel M, Busse WW et al (2020) An expert consensus framework for asthma remission as a treatment goal. J Allergy Clin Immunol 145(3):757–765 CrossRef Menzies-Gow A, Bafadhel M, Busse WW et al (2020) An expert consensus framework for asthma remission as a treatment goal. J Allergy Clin Immunol 145(3):757–765 CrossRef
26.
Zurück zum Zitat Menzies-Gow A, Szefler SJ, Busse WW (2021) The relationship of asthma biologics to remission for asthma. J Allergy Clin Immunol Pract 9(3):1090–1098 CrossRef Menzies-Gow A, Szefler SJ, Busse WW (2021) The relationship of asthma biologics to remission for asthma. J Allergy Clin Immunol Pract 9(3):1090–1098 CrossRef
27.
Zurück zum Zitat Usmani OS (2019) Choosing the right inhaler for your asthma or COPD patient. Ther Clin Risk Manag 15:461–472 CrossRef Usmani OS (2019) Choosing the right inhaler for your asthma or COPD patient. Ther Clin Risk Manag 15:461–472 CrossRef
28.
Zurück zum Zitat Virchow JC, Backer V, Kuna P et al (2016) Efficacy of a house dust mite sublingual allergen immunotherapy tablet in adults with allergic asthma: a randomized clinical trial. JAMA 315(16):1715–1725 CrossRef Virchow JC, Backer V, Kuna P et al (2016) Efficacy of a house dust mite sublingual allergen immunotherapy tablet in adults with allergic asthma: a randomized clinical trial. JAMA 315(16):1715–1725 CrossRef
29.
Zurück zum Zitat O’Byrne PM, Reddel HK, Eriksson G et al (2010) Measuring asthma control: a comparison of three classification systems. Eur Respir J 36(2):269–276 CrossRef O’Byrne PM, Reddel HK, Eriksson G et al (2010) Measuring asthma control: a comparison of three classification systems. Eur Respir J 36(2):269–276 CrossRef
30.
Zurück zum Zitat Weiler JM, Brannan JD, Randolph CC et al (2016) Exercise-induced bronchoconstriction update-2016. J Allergy Clin Immunol 138(5):1292–1295.e3 CrossRef Weiler JM, Brannan JD, Randolph CC et al (2016) Exercise-induced bronchoconstriction update-2016. J Allergy Clin Immunol 138(5):1292–1295.e3 CrossRef
31.
Zurück zum Zitat Sobieraj DM, Weeda ER, Nguyen E et al (2018) Association of inhaled corticosteroids and long-acting beta-agonists as controller and quick relief therapy with exacerbations and symptom control in persistent asthma: a systematic review and meta-analysis. JAMA 319(14):1485–1496 CrossRef Sobieraj DM, Weeda ER, Nguyen E et al (2018) Association of inhaled corticosteroids and long-acting beta-agonists as controller and quick relief therapy with exacerbations and symptom control in persistent asthma: a systematic review and meta-analysis. JAMA 319(14):1485–1496 CrossRef
32.
Zurück zum Zitat Beasley R, Harper J, Bird G, Maijers I, Weatherall M, Pavord ID (2019) Inhaled corticosteroid therapy in adult asthma. Time for a new therapeutic dose terminology. Am J Respir Crit Care Med 199(12):1471–1477 CrossRef Beasley R, Harper J, Bird G, Maijers I, Weatherall M, Pavord ID (2019) Inhaled corticosteroid therapy in adult asthma. Time for a new therapeutic dose terminology. Am J Respir Crit Care Med 199(12):1471–1477 CrossRef
33.
Zurück zum Zitat Buhl R, FitzGerald JM, Busse WW (2018) Tiotropium add-on to inhaled corticosteroids versus addition of long-acting beta2-agonists for adults with asthma. Respir Med 143:82–90 CrossRef Buhl R, FitzGerald JM, Busse WW (2018) Tiotropium add-on to inhaled corticosteroids versus addition of long-acting beta2-agonists for adults with asthma. Respir Med 143:82–90 CrossRef
34.
Zurück zum Zitat Wang L, Zhou R, Xie X (2019) Tiotropium added to low- to medium-dose inhaled corticosteroids (ICS) versus low- to medium-dose ICS alone for adults with mild to moderate uncontrolled persistent asthma: a systematic review and meta-analysis. J Asthma 56(1):69–78 CrossRef Wang L, Zhou R, Xie X (2019) Tiotropium added to low- to medium-dose inhaled corticosteroids (ICS) versus low- to medium-dose ICS alone for adults with mild to moderate uncontrolled persistent asthma: a systematic review and meta-analysis. J Asthma 56(1):69–78 CrossRef
35.
Zurück zum Zitat Virchow JC, Kuna P, Paggiaro P et al (2019) Single inhaler extrafine triple therapy in uncontrolled asthma (TRIMARAN and TRIGGER): two double-blind, parallel-group, randomised, controlled phase 3 trials. Lancet 394(10210):1737–1749 CrossRef Virchow JC, Kuna P, Paggiaro P et al (2019) Single inhaler extrafine triple therapy in uncontrolled asthma (TRIMARAN and TRIGGER): two double-blind, parallel-group, randomised, controlled phase 3 trials. Lancet 394(10210):1737–1749 CrossRef
36.
Zurück zum Zitat Lee LA, Bailes Z, Barnes N et al (2021) Efficacy and safety of once-daily single-inhaler triple therapy (FF/UMEC/VI) versus FF/VI in patients with inadequately controlled asthma (CAPTAIN): a double-blind, randomised, phase 3A trial. Lancet Respir Med 9(1):69–84 CrossRef Lee LA, Bailes Z, Barnes N et al (2021) Efficacy and safety of once-daily single-inhaler triple therapy (FF/UMEC/VI) versus FF/VI in patients with inadequately controlled asthma (CAPTAIN): a double-blind, randomised, phase 3A trial. Lancet Respir Med 9(1):69–84 CrossRef
38.
Zurück zum Zitat Lommatzsch M, Virchow CJ (2014) Severe asthma: definition, diagnosis and treatment. Dtsch Arztebl Int 111(50):847–855 PubMedPubMedCentral Lommatzsch M, Virchow CJ (2014) Severe asthma: definition, diagnosis and treatment. Dtsch Arztebl Int 111(50):847–855 PubMedPubMedCentral
39.
Zurück zum Zitat Global Initiative for Asthma (GINA) (2020) Difficult-to-treat and severe asthma in adolescents and adult patients: diagnosis and management. www.​ginasthma.​org. Zugegriffen: 25. Jan. 2022 Global Initiative for Asthma (GINA) (2020) Difficult-to-treat and severe asthma in adolescents and adult patients: diagnosis and management. www.​ginasthma.​org. Zugegriffen: 25. Jan. 2022
40.
Zurück zum Zitat Menzies-Gow A, Corren J, Bourdin A et al (2021) Tezepelumab in adults and adolescents with severe, uncontrolled asthma. N Engl J Med 384(19):1800–1809 CrossRef Menzies-Gow A, Corren J, Bourdin A et al (2021) Tezepelumab in adults and adolescents with severe, uncontrolled asthma. N Engl J Med 384(19):1800–1809 CrossRef
41.
Zurück zum Zitat Lommatzsch M, Stoll P, Winkler J et al (2021) Eosinophilic pleural effusion and stroke with cutaneous vasculitis: two cases of dupilumab-induced hypereosinophilia. Allergy 76(9):2920–2923 CrossRef Lommatzsch M, Stoll P, Winkler J et al (2021) Eosinophilic pleural effusion and stroke with cutaneous vasculitis: two cases of dupilumab-induced hypereosinophilia. Allergy 76(9):2920–2923 CrossRef
43.
Zurück zum Zitat Bornstein SR, Allolio B, Arlt W et al (2016) Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 101(2):364–389 CrossRef Bornstein SR, Allolio B, Arlt W et al (2016) Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 101(2):364–389 CrossRef
Metadaten
Titel
Diagnostik und Therapie von Asthma bei Erwachsenen
verfasst von
Prof. Dr. Marek Lommatzsch
Publikationsdatum
15.02.2022
Verlag
Springer Medizin
Erschienen in
Zeitschrift für Pneumologie / Ausgabe 2/2022
Print ISSN: 2731-7404
Elektronische ISSN: 2731-7412
DOI
https://doi.org/10.1007/s10405-022-00433-5