Although severe asthma accounts for only around 5% of
people with asthma, it contributes to approximately 50%
of the economic costs of asthma; therefore novel therapies
have been developed for optimal treatment of these
patients. If severe asthma is suspected, differential diagnoses
that may mimic asthma should first be ruled out followed
by ruling out diseases associated with asthma and poor
treatment adherence and/or persistent triggers. The use of
tiotropium, omalizumab, mepolizumab and thermoplasty
in well-selected patients provides better control and most
importantly a reduction in asthma exacerbations. In the
next few years multiple other targeted treatments for
severe asthma will become available. The challenge will be
to ensure these therapies are provided to the appropriate
patient and also that given there inherent high costs that
they are rigorously evaluated for there cost effectiveness.