A new perspective on concepts of asthma severity and control

Abstract

Concepts of asthma severity and control are important in the evaluation of patients and their response to treatment but the terminology is not standardised and the terms are often used interchangeably. This review, arising from the work of an American Thoracic Society/European Respiratory Society Task Force, identifies the need for separate concepts of control and severity, describes their evolution in asthma guidelines and provides a framework for understanding the relationship between current concepts of asthma phenotype, severity and control.''Asthma control'' refers to the extent to which the manifestations of asthma have been reduced or removed by treatment. Its assessment should incorporate the dual components of current clinical control (e.g. symptoms, reliever use and lung function) and future risk (e.g. exacerbations and lung function decline).The most clinically useful concept of asthma severity is based on the intensity of treatment required to achieve good asthma control, i.e. severity is assessed during treatment. Severe asthma is defined as the requirement for (not necessarily just prescription or use of) highintensity treatment. Asthma severity may be influenced by the underlying disease activity and by the patient's phenotype, both of which may be further described using pathological and physiological markers. These markers can also act as surrogate measures for future risk.

Effects of omalizumab in severe asthmatics across ages: A real life Italian experience

“…In fact, FEV 1 and ACT increased whereas, exacerbations, ICS dosage and SABA used as rescue medications decreased significantly after approximately a 3-year Omalizumab treatment in all groups, independently of age.…”

“…Severe asthma is defined as the requirement for high-intensity treatment to obtain a disease control (1). However, despite using high doses of inhaled corticosteroids (ICS), bronchodilators and anti-leukotriens, we sometimes fail to achieve asthma control.…”

Asthma Control Assessment Tools

“…1,4,5 However, discordance between the patient's and clinician's assessment of the patient's level of asthma control were reported in several studies. 1,6 Also, both clinicians and patients often overestimate the level of asthma control. [7][8][9] Thus, clinicians suboptimally manage asthma, and patients under-report asthma symptoms and may fail to recognize the impact that asthma has on their daily life.…”

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

“…42 The dual concepts of asthma severity and asthma control have been widely discussed. [43][44][45] Recent guidelines have changed their emphasis from classification of severity to the goal of achieving asthma control, 12 prioritising the objective assessment of control. …”