Management of difficult to treat severe asthma—what's the evidence?

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The management of adults with asthma that remains uncontrolled despite treatment with high-dose therapies poses a challenge to clinicians and patients. National and international guidelines recommend intensification of treatment that typically involves the use of oral corticosteroids.1,2 The risks associated with long-term systemic corticosteroid treatment are well documented, and have led to the search for alternatives. Recent advances in the understanding of the pathology of asthma have prompted the development of other treatment options. Here, we consider the options available for people who require continuous or frequent use of oral corticosteroids and review the safety and efficacy of such treatments.

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