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Severe asthma: Epidemiology, burden of illness, and heterogeneity

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Patients with severe persistent asthma comprise only 5‐10 % of the total asthma population, but account for a large proportion of asthma morbidity and health care expenditures. Among patients with severe asthma, higher costs can be expected in association with not well or poorly controlled asthma.


To summarize the evidence concerning the epidemiology, burden, and heterogeneity of severe asthma.


A literature search was performed to identify citations using the terms “severe asthma” and “epidemiology”, “asthma control”, “asthma” and “heterogeneity”.


Successful management of patients with severe asthma continues to be a major unmet need. One of the barriers to successful management is the heterogeneity of asthma. Asthma is not one disease; it is a disorder that can be subdivided into a number of different phenotypes and endotypes. A revised paradigm for asthma management, that entails categorization of asthma patients via use of “biomarkers”, and prescribing targeted therapy, will supplant what has been a “one size fits all” approach to asthma management.


The novel approach to asthma management, in which therapy will be more mechanism-specific based on phenotype/endotype, offers the potential for improved asthma care outcomes ‐ particularly for patients with severe persistent asthma who are not well or poorly controlled.
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Keywords: Asthma; asthma control; asthma heterogeneity; asthma severity

Document Type: Research Article

Affiliations: Respiratory Institute, Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio, USA

Publication date: November 1, 2015

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma and by having the potential to directly impact the quality of patient care. AAP welcomes the submission of original works including peer-reviewed original research and clinical trial results. Additionally, as the official journal of the Eastern Allergy Conference (EAC), AAP will publish content from EAC poster sessions as well as review articles derived from EAC lectures.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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