The Saudi Initiative for Asthma - 2019 Update: Guidelines for the diagnosis and management of asthma in adults and children

Abstract

This is the fourth version of the updated guidelines for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of the SINA is to have guidelines that are up to date, simple to understand, and easy to use by healthcare workers dealing with asthma patients. To facilitate achieving the goals of asthma management, the SINA panel approach is mainly based on the assessment of symptom control and risk for both adults and children. The approach to asthma management is now more aligned for different age groups. The guidelines have focused more on personalized approaches reflecting better understanding of disease heterogeneity with integration of recommendations related to biologic agents, evidence-based updates on treatment, and role of immunotherapy in management. The medication appendix has also been updated with the addition of recent evidence, new indications for existing medication, and new medications. The guidelines are constructed based on the available evidence, local literature, and current situation at national and regional levels. There is also an emphasis on patient–doctor partnership in the management that also includes a self-management plan.

Biologic therapy in severe asthma: An update

“…The fourth category is a paucigranulocytic phenotype with airway limitation caused by other mechanisms. It is the least common and patients usually have milder disease [2]. Different drug targets had been discovered leading to the advancement of biologic agents to treat patients who are not responsive to ICS, including IgE, IL-4/13, and IL-5, IL-17, TSLP, in addition to many others being investigated.…”

“…Mepolizumab should be prescribed cautiously to patients older than 65 years with severe asthma due to a higher potential for increased sensitivity. There are insuf icient data for using mepolizumab in pregnancy, lactation, or a pediatric population less than 12 years of age [2,4,11,17].…”

“…The Saudi Initiative for Asthma (SINA 2019) stated that all IL-5 antibody including mepolizumab should be continued for 6-12 months. The guidelines was published before the COLUMBA study release and the duration of mepolizumab use might be exempted from the general role for IL-5 antibodies [2,23,24]. Castro, et al in their randomized, double-blind, placebocontrolled study conducted in 2011, using 53 patients with severe eosinophilic asthma who were not controlled on a high dose of ICS, report a signi icant reduction in sputum and blood eosinophils (95.45% vs. 38.75% in placebo group, P = 0.0068).…”

“…It is characterised by a history of respiratory symptoms such as wheezing, dyspnea, chest tightness and cough varying over time and intensity, as well as expiratory air low limitation [1]. Asthma symptoms are either episodic or persistent, affecting up to 18% of the Saudi population and prevalent in both adults and children [2][3][4][5]. Symptom control in the majority of asthma patients is usually achieved with the gold standard regimen, inhaled corticosteroid (ICS), however approximately 20% of patients do not achieve control, increasing mortality, morbidity and overall healthcare cost [4].…”

Knowledge on Self-Management and Level of Asthma Control among Adult Asthmatic Patients Attending Kalar General Hospital

“…According to Global Asthma Report (2018), asthma control focuses on two main domains; fist reducing impairment the frequency and intensity of symptoms and functional limitations currently or recently experienced by a patient; secondly reducing risk the likelihood of future asthma attacks, progressive decline in lung function, or medication side effects. [2] Achieving and maintaining asthma control requires providing appropriate medication, addressing environmental factors that cause worsening symptoms, helping patients learn self-management knowledge skills and monitoring over the long term to assess control and adjust therapy accordingly [2,4,5].…”