Editors Liam G Heaney MD MRCP
Professor of Respiratory Medicine School of Medicine, Dentistry and Biological Sciences Queens University Belfast
Belfast, Northern Ireland, UK
Andrew Menzies-Gow BSc MBBS PhD FRCP
Consultant Physician in Respiratory Medicine Royal Brompton Hospital
London, England, UK
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Clinical Focus Series
Difficult Asthma / Eds. Liam G Heaney, Andrew Menzies-Gow
First Edition: 2013
9789350902998
Printed at:
7Contributors
EDITORS
- Liam G Heaney MD MRCP
- Professor of Respiratory Medicine
- School of Medicine, Dentistry and Biological Sciences
- Queens University Belfast
- Belfast, Northern Ireland, UK
- Andrew Menzies-Gow BSc MBBS PhD FRCP
- Consultant Physician in Respiratory Medicine
- Royal Brompton Hospital
- London, England, UK
CONTRIBUTING AUTHORS
- Ian M Adcock PhD FSB
- Professor
- Respiratory Cell and Molecular Biology
- National Heart and Lung Institute
- Imperial College London
- London, England, UK
- Christopher Brightling MRCP PhD
- Wellcome Senior Clinical Fellow
- Honorary Consultant
- Institute for Lung Health
- Leicester, England, UK
- Rekha Chaudhuri MD
- Associate Specialist and Honorary Senior Clinical Lecturer
- Department of Respiratory Medicine
- Gartnavel General Hospital and University of Glasgow
- Glasgow, Scotland, UK
- Kian F Chung MD DSc FRCP
- Professor of Respiratory Medicine and Head of Experimental Studies
- National Heart and Lung Institute
- Imperial College London
- London, England, UK
- Rob Horne BSc MSc PhD FRPharmS
- Professor of Behavioural Medicine
- Head of Department of Practice and Policy
- Director, Centre for Behavioural Medicine
- UCL School of Pharmacy
- London, England, UK
- Adel H Mansur PhD FRCP
- Department of Respiratory
- Birmingham Heartlands Hospital
- Robert Niven MBChB BSc MD MFOM FRCP
- Senior Lecturer in Respiratory Medicine
- The University of Manchester and University Hospital of South Manchester
- North West Lung Centre
- University Hospital of South Manchester
- Manchester, England, UK
- Ciaran O'Neill BSc PhD
- Professor of Health Technology Assessment
- Cairns School of Business and Economics
- National University of Galway
- Galway, Ireland
- Alison Pooler PhD MSc BSc PGCHPE RGN RNT
- School of Nursing and Midwifery
- Keele University
- Staffordshire, England, UK
- Michael D Shields MBChB MD FRCP FRCPCH
- Professor of Child Health and Consultant Pediatrician
- Queen's University Belfast and Royal Belfast Hospital for Sick Children
- Belfast, Northern Ireland, UK
- Annemarie Sykes MBBS MRCP PhD
- Clinical Lecturer
- Respiratory Medicine, Imperial College London
- London, England, UK
- Claire Telford
- Centre for Public Health
- School of Medicine, Dentistry and Biomedical Sciences
- Queen's University Belfast
- Belfast, Northern Ireland, UK
- Surendran Thavagnanam MBBCh BAO MD MRCPCH
- Associate Professor and Consultant Pediatrician
- University Malaya and University Malaya Medical Centre
- Lembah Pantai, Kuala Lumpur, Malaysia
- Neil C Thomson MBChB MD FRCP
- Professor
- Institute of Infection, Immunity, and Inflammation
- University of Glasgow
- Glasgow, Scotland, UK
- Jennifer M Versnel BSc MSc MPhil
- Business Innovation Consultant
- Asthma UK
- London, England, UK
- Sally E Wenzel MD
- Director
- University of Pittsburgh Asthma Institute
- Pittsburgh, Pennsylvania, USA
Asthma is common and affects an estimated 300 million people worldwide. The diagnosis is often straightforward, and symptoms respond well to standard doses of inhaled therapy. However, approximately 5–10% of patients with asthma do not respond well and have poor symptomatic control, despite prescription of currently available therapies. These patients are often referred to as having “difficult asthma”. This poor response to conventional therapy is not always due to underlying asthma severity. Systematic multidisciplinary approaches to clinical evaluation have sought to dissect the complexity of this clinical population and demonstrated how targeted intervention can improve outcome. Some patients do have severe refractory disease, where there is a suboptimal response to currently available therapies, and in these cases, novel therapies, including specific monoclonal antibodies against key biological targets, are becoming available.
The purpose of this book is to provide medical students, postgraduate fellows, general practitioners, and specialists a succinct, easy-to-read, well-illustrated, and comprehensive review of difficult asthma. The book brings together the opinion of international experts in the field and provides a pragmatic overview of the clinical problems, giving an insight into the complexity of this population and providing a framework for managing these patients. It covers the etiology, pathogenesis, and management of refractory asthma and novel therapeutic approaches in this group. Importantly, it gives an insight into the patient's perspective of severe asthma and the associated disproportionate use of healthcare resources and major economic burden of poorly controlled asthma.
We hope that this book will be of use not only for pulmonologists and internists but also for practitioners of other specialties, because this clinical problem is often encountered by nonpulmonologists.
Finally, we would like to record our sincere thanks to the group of international physicians and academicians who, despite their busy schedules, provided outstanding educational material for this book.
Liam G Heaney
11Acknowledgments
We would like to acknowledge the huge effort from the international experts who have contributed to this book. When approached about the project, all responded with great enthusiasm, reflecting their passion to promote understanding and improve care for patients with difficult-to-control asthma.