Severe Persistent Asthma Management with Tezepelumab

Patient Assessment and Criteria

The American College of Allergy, Asthma, and Immunology recommends that patients with severe persistent asthma demonstrate clear evidence of severe persistent asthma with symptoms throughout the day, requiring rescue inhaler use, and a history of frequent exacerbations requiring oral corticosteroids 3, 4
Patients with severe asthma should have an Asthma Control Test score indicating uncontrolled asthma, and have been on multiple controller medications but continue to have poor asthma control 3
The patient meets the clinical indications for tezepelumab as she is over 12 years of age and has severe asthma that remains uncontrolled despite treatment with high-dose inhaled corticosteroids plus second controllers 3, 5

The Journal of Allergy and Clinical Immunology suggests confirming severe persistent asthma diagnosis with daily symptoms, frequent nighttime awakenings, SABA use multiple times per week, and significant limitation in normal activities 3, 4
Verify inadequate control on current therapy with patient on high-dose ICS plus multiple controllers, continues to have symptoms requiring rescue medication, and recent exacerbation requiring oral corticosteroids 3, 4, 5

The American Academy of Family Physicians recommends regular follow-up visits every 1-3 months initially to assess response to therapy, and monitor asthma control using validated questionnaires (ACT score) 3, 4, 7
Assess frequency of rescue medication use and exacerbations, and perform spirometry at baseline and periodically to assess lung function improvement 3, 7

The American College of Allergy, Asthma, and Immunology advises against failing to recognize severe persistent asthma that requires escalation to biologic therapy, and using long-acting beta-agonists as monotherapy without inhaled corticosteroids 2
Not addressing comorbid conditions that may worsen asthma control, and delaying referral to a specialist for severe asthma management 2, 7