ALAT-SEPAR Consensus on the Definition and Classification of Asthma Exacerbations by Severity: a Move toward International Standardization

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Ana Stok
https://orcid.org/0000-0002-1810-9130
Francisco Álvarez-Gutiérrez
https://orcid.org/0000-0002-0175-2824
Marina Blanco-Aparicio
https://orcid.org/0000-0002-5012-1746
Francisco Casas-Maldonado
https://orcid.org/0000-0002-8007-9323
Carmen Cano
Patricia Fernández
https://orcid.org/0009-0008-7434-9690
Gabriel García
Alicia Padilla-Galo
https://orcid.org/0000-0003-4625-2716
Vicente Plaza
https://orcid.org/0000-0003-2567-5496
Ignacio Zabert
https://orcid.org/0000-0002-8693-5901
José Gregorio Soto Campos
https://orcid.org/0000-0003-4052-0417

Abstract

Asthma exacerbation is a significant clinical event that occurs with varying severity, yet a set of universally accepted standardized definitions is still needed. The aim of this consensus developed by ALAT and SEPAR was to fill this gap with a validated proposal for classifying asthma exacerbations into levels of severity: non-severe, severe, and very severe.


The consensus was based on an in-depth review of the literature conducted by the scientific committee to identify key parameters for each level of severity, including worsening symptoms, respiratory function changes, and the need for specific medical interventions. A total of 67 publications were analyzed to generate a questionnaire on the defining elements of asthma exacerbations, and this was put to the vote. Twenty-eight international experts participated in the validation of characteristics and definitions of exacerbation severity following Delphi methodology. The resulting definitions clearly distinguish non-severe exacerbations (requiring minor adjustments in treatment) from severe exacerbations (requiring more intensive interventions, including longer systemic corticosteroid use or hospitalization) and very severe exacerbations (life-threatening events requiring intensive care). These definitions provide a standardized framework that facilitates comparison between clinical trials and optimizes patient care.


This consensus lays the foundation for unifying management criteria in global clinical practice and fostering research on the efficacy of asthma treatments. It also underlines the importance of accurate classification in improving clinical outcomes and reducing the overall burden of disease.

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How to Cite

ALAT-SEPAR Consensus on the Definition and Classification of Asthma Exacerbations by Severity: a Move toward International Standardization. (2025). Respirar, 17(4), 385-422. https://doi.org/10.55720/respirar.17.4.2

References

1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention 2023. 2023. [Internet]. [Consultado 3 jul 2025]. Disponible en: https://ginasthma.org/2023-gina-main-report/

2. Asher MI, Garcia-Marcos L, Pearce NE, Strachan DP. Trends in worldwide asthma prevalence. Eur Respir J 2020;56:2002094. Doi: https://doi.org/10.1183/13993003.02094-2020

3. Arias SJ, Neffen H, Bossio JC et al. Prevalence and Features of Asthma in Young Adults in Urban Areas of Argentina. Arch Bronconeumol (Engl Ed) 2018;54:134-9. Doi: https://doi.org/10.1016/j.arbres.2017.08.021

4. Ocampo J, Gaviria R, Sanchez J. [Prevalence of asthma in Latin America. Critical look at ISAAC and other studies]. Rev Alerg Mex 2017;64:188-97. Doi: https://doi.org/10.29262/ram.v64i2.256

5. Noriega L, Méndez J, Trujillo A, Aguilera A, García Y. Prevalencia y características del asma en mayores de 18 años en la República de Panamá: estudio de base poblacional PRENFOR. Open Respiratory Archives 2020;2:113-8. Doi: https://doi.org/10.1016/j.opresp.2020.04.002

6. Diseases GBD, Injuries C. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020;396:1204-22. Doi: https://doi.org/10.1016/S0140-6736(20)30925-9

7. Cano-Salas MDC, Miguel-Reyes JL, Sanchez-Trejo K et al. [Economic burden assessment for the management of asthma patients at Mexico's National Institute for Respiratory Diseases]. Rev Alerg Mex 2024;71:12-22. Doi: https://doi.org/10.29262/ram.v71i1.1279

8. Martinez-Moragon E, Serra-Batlles J, De Diego A et al. [Economic cost of treating the patient with asthma in Spain: the AsmaCost study]. Arch Bronconeumol 2009;45:481-6. Doi: https://doi.org/10.1016/j.arbres.2009.04.006

9. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention 2022. 2022 [Internet]. [Consultado 3 jul 2025]. Disponible en: https://ginasthma.org/gina-reports/

10. Comité Ejecutivo GEMA. Guía española para el manejo del asma (GEMA) versión 5.2. 2022. [Internet]. [Consultado 3 jul 2025]. Disponible en: https://se-fc.org/wp-content/uploads/2022/05/GEMA-5.2-Final.pdf

11. Chung KF, Wenzel SE, Brozek JL et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014;43:343-73. Doi: https://doi.org/10.1183/09031936.00202013

12. Beasley R, Beckert L, Fingleton J et al. Asthma and Respiratory Foundation NZ Adolescent and Adult Asthma Guidelines 2020: a quick reference guide. N Z Med J 2020;133:73-99.

13. Kruszewski J, Chazan R, Kuziemski K et al. Management of asthma exacerbation in adults: guidelines for primary care doctors. Pol Arch Intern Med 2019;129:842-9. Doi: https://doi.org/10.20452/pamw.14978

14. Bourdin A, Bjermer L, Brightling C et al. ERS/EAACI statement on severe exacerbations in asthma in adults: facts, priorities and key research questions. Eur Respir J 2019;54:1900900. Doi: https://doi.org/10.1183/13993003.00900-2019

15. Agusti A, Barnes N, Cruz AA et al. Moving towards a Treatable Traits model of care for the management of obstructive airways diseases. Respir Med 2021;187:106572. Doi: https://doi.org/10.1016/j.rmed.2021.106572

16. Cloutier MM, Dixon AE, Krishnan JA, Lemanske RFJr, Pace W, Schatz M. Managing Asthma in Adolescents and Adults: 2020 Asthma Guideline Update From the National Asthma Education and Prevention Program. JAMA 2020;324:2301-17. Doi: https://doi.org/10.1001/jama.2020.21974

17. Ohta K, Adachi M, Tohda Y et al. Efficacy and safety of benralizumab in Japanese patients with severe, uncontrolled eosinophilic asthma. Allergol Int 2018;67:266-72. Doi: https://doi.org/10.1016/j.alit.2017.10.004

18. Fitch K, Bernstein SJ, Aguilar MD et al. The Rand/UCLA appropriateness method user's manual. Santa Monica: RAND; 2001

19. Bernstein JA, Virchow JC, Murphy K et al. Effect of fixed-dose subcutaneous reslizumab on asthma exacerbations in patients with severe uncontrolled asthma and corticosteroid sparing in patients with oral corticosteroid-dependent asthma: results from two phase 3, randomised, double-blind, placebo-controlled trials. Lancet Respir Med 2020;8:461-74. Doi: https://doi.org/10.1016/S2213-2600(19)30372-8

20. Busse WW, Maspero JF, Lu Y et al. Efficacy of dupilumab on clinical outcomes in patients with asthma and perennial allergic rhinitis. Ann Allergy Asthma Immunol 2020;125:565-76 e1. Doi: https://doi.org/10.1016/j.anai.2020.05.026

21. Lee LA, Bailes Z, Barnes N et al. Efficacy and safety of once-daily single-inhaler triple therapy (FF/UMEC/VI) versus FF/VI in patients with inadequately controlled asthma (CAPTAIN): a double-blind, randomised, phase 3A trial. Lancet Respir Med 2021;9:69-84. Doi: https://doi.org/10.1016/S2213-2600(20)30389-1

22. Bleecker ER, Wechsler ME, FitzGerald JM et al. Baseline patient factors impact on the clinical efficacy of benralizumab for severe asthma. Eur Respir J 2018;52. Doi: https://doi.org/10.1183/13993003.00936-2018

23. Goldman M, Hirsch I, Zangrilli JG, Newbold P, Xu X. The association between blood eosinophil count and benralizumab efficacy for patients with severe, uncontrolled asthma: subanalyses of the Phase III SIROCCO and CALIMA studies. Curr Med Res Opin 2017;33:1605-13. Doi: https://doi.org/10.1080/03007995.2017.1347091

24. Reddel HK, Taylor DR, Bateman ED et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med 2009;180:59-99. Doi: https://doi.org/10.1164/rccm.200801-060ST

25. Virchow JC, Backer V, de Blay F et al. Defining moderate asthma exacerbations in clinical trials based on ATS/ERS joint statement. Respir Med 2015;109:547-56. Doi: https://doi.org/10.1016/j.rmed.2015.01.012

26. Ramakrishnan S, Russell REK, Mahmood HR et al. Treating eosinophilic exacerbations of asthma and COPD with benralizumab (ABRA): a double-blind, double-dummy, active placebo-controlled randomised trial. Lancet Respir Med 2025;13:59-68. Doi: https://doi.org/10.1016/S2213-2600(24)00299-6

27. Albers FC, Mullerova H, Gunsoy NB et al. Biologic treatment eligibility for real-world patients with severe asthma: The IDEAL study. J Asthma 2018;55:152-60. Doi: https://doi.org/10.1080/02770903.2017.1322611

28. Canonica GW, Harrison TW, Chanez P et al. Benralizumab improves symptoms of patients with severe, eosinophilic asthma with a diagnosis of nasal polyposis. Allergy 2022;77:150-61. Doi: https://doi.org/10.1111/all.14902

29. Perez de Llano LA, Cosio BG, Domingo C et al. Efficacy and Safety of Reslizumab in Patients with Severe Asthma with Inadequate Response to Omalizumab: A Multicenter, Open-Label Pilot Study. J Allergy Clin Immunol Pract 2019;7:2277-83 e2. Doi: https://doi.org/10.1016/j.jaip.2019.01.017

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