Systemic side effects are the main limitation of glucocorticoids that are essential for treatment of bronchial asthma. Their risk is higher in patients with severe asthma who frequently require high doses, prolonged treatment and oral administration. Over the last 50 years, various agents with potential steroid-sparing activity were tested in clinical studies. The efficacy of cytostatics and calcineurin inhibitors was not proven both in oral or aerosol formulations, whereas monoclonal antibodies blocking IgE or cytokins have emerged as an effective option for severe, treatment-refractory asthma.
Severe bronchial asthma, phenotypes, endotypes, immunosuppressive agents, steroid-sparing activity, aerosols.