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. 2022 May 28;135(10):1141–1155. doi: 10.1097/CM9.0000000000001990

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Management algorithm for severe asthma. After confirming the diagnosis of severe asthma, Type-2 (T2) biomarkers which are currently based on blood eosinophil count, fractional exhaled nitric oxide (FeNO) and total serum immunoglobulin E (IgE) and presence of allergies can be used to diagnose severe eosinophilic or severe allergic asthma. Those with high-T2 biomarker and regular exacerbations of asthma can be offered biologic anti-T2 treatments. Those with low T2-biomarker will need to have a reduction in oral corticosteroid dosage (OCS) in case the steroids are suppressing the level of T2-biomarkers. Trial of long-term azithromycin or bronchial thermoplasty may be considered. IL: Interleukin; IL4Rα: Interleukin 4 receptor alpha; IL5Rα: Interleukin 5 receptor alpha; ppb: Part per billion; SPT: Skin prick tests; sIgE: Specific immunoglobulin E.