World Allergy Congress 2007 Symposium

Acute and Severe Asthma

Bobby Q. Lanier
North Texas Institute for Clinical Trials
Fort Worth, Texas, USA

Bob Lanier, MD is a practicing allergist and past president of the American College of Allergy, Asthma and Immunology (ACAAI). In addition, he is founder and executive vice president of the Society of Principal Investigators, and medical director of North Texas Institute for Clinical Trials. Dr. Lanier is clinical professor of Pediatrics, University of North Texas Health Science Center.

Dr. Lanier is board certified in Pediatrics and Allergy/Immunology, and he was director of fellowship training at the USAF Wilford Hall Medical Center for pediatric immunology until entering private practice in 1977. He has served as President of the American Association of Certified Allergists, the Texas Medical Association Foundation, and the Tarrant County Medical Association. He has been named a Distinguished Fellow by the ACAAI and a Distinguished Alumnus of Lamar University.

In addition to a long and successful career as a broadcaster on medical topics, Dr. Lanier has served as contributing editor of the Annals of the American College of Allergy, Asthma and Immunology, the John Hopkins Asthma Monitor, and the Proceedings of Allergy and Immunology. He has over 60 contributions in peer reviewed journals as well as textbook chapters in Immunology with emphasis on anti-IgE in allergy.

Abstract

Severe asthma as manifest by the continuous high dose of inhaled corticosteroids, or oral corticosteroids for >50% of the previous year, remains a huge problem despite significant advances in pharmacotherapy. As many as 5-10% of all asthma hospitalizations result in ICU admission, with an overall mortality rate of 0.4%. Hallmarks of severe asthma include polymorphisms in the beta-2 receptor, arginine substitutions at position 16 (Arg/Arg), a female gender, diminished perception of dyspnea, and steroid resistance. A protocol for evaluation and immediate therapy is suggested based on a review of the literature.

References

1. 2002. Global Initiative for Asthma: Global Strategy for Asthma Management and Prevention (GINA). National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda. 1-9.
2. 1997. National Asthma Education and Prevention Program Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma Publication No. 97-4051 (NAEPP). US Department of Health & Human Services.
3. Wenzel SE, Fahy JV, Irvin CG, Peters SP, Spector S, and Szefler SJ. Proceedings of the ATS Workshop on Refractory Asthma - Current understanding, recommendations and unanswered questions. Am. J. Respir. Crit. Care Med. 2000;162:2341-2351.
4. Miranda C, Busacker A, Balzar S, Trudeau J, and Wenzel SE. Distinguishing severe asthma phenotypes: role of age at onset and eosinophilic inflammation. J Allergy Clin Immunol 2004;113(1):101-8.
5. Sandford AJ, Chagani T, Zhu S, Weir TD, Bai TR, Spinelli JJ, Fitzgerald JM, Behbehani NA, Tan WC, and Pare PD. Polymorphisms in the IL4, IL4RA, and FCERIB genes and asthma severity. J. Allergy Clin. Immunol. 2000;106(1 Pt 1):135-140.

Slide presentation

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