TABLE 3

Recommendation summaries and the level of evidence

RecommendationsLevel of evidenceGrade of recommendationJudgement
6There is not enough good-quality evidence to support the on-demand use of an ICS plus formoterol in patients with severe asthma1+BConditional
9Tiotropium (LAMA) should be considered as a third controller added to ICS plus LABA treatment in children >6 years of age and adults1−BConditional
10We recommend the use of omalizumab in adult patients and children with severe uncontrolled allergic asthma (cut-off values >30 IU)1+ (adults)
1− (children)
A
A
Strong
Strong
11We recommend the use of monoclonal anti-IL-5 antibodies in patients with severe uncontrolled eosinophilic asthma (cut-off values >150 cells·µL−1 for mepolizumab and >400 cells·µL−1 for reslizumab) There is no evidence to recommend the use of monoclonal anti-IL-5 antibodies in children1+ (adults)
1− (children)
A
B
Strong
Conditional recommendation for use restricted to trials
12We recommend the use of benralizumab in patients with severe uncontrolled eosinophilic asthma (cut-off values >300 cells·µL−1) There is no evidence to recommend the use of monoclonal anti-IL-5 antibodies in children1+ (adults)
1− (children)
AStrong
Conditional recommendation for use restricted to trials
14We recommend the use of dupilumab in adult patients with severe allergic and eosinophilic uncontrolled asthma and in adult patients with severe corticosteroid-dependent asthma
Lebrikizumab and tralokinumab have not been able to demonstrate consistent efficacy in the most important outcomes in patients with severe asthma; therefore, we do not suggest their use
1+ (adults)
1+ (adults)
A
A
Strong
Strong recommendation against

Recommendations synthesis and judgement. ICS: inhaled corticosteroid; LAMA: long-acting anticholinergics; LABA: long-acting bronchodilator; IL: interleukin.