Asthma control or severity: that is the question

Abstract

In the first National Heart Lung and Blood Institute and Global Initiative for Asthma (GINA) guidelines, the level of symptoms and airflow limitation and its variability allowed asthma to be subdivided by severity into four subcategories (intermittent, mild persistent, moderate persistent, and severe persistent). It is important to recognize, however, that asthma severity involves both the severity of the underlying disease and its responsiveness to treatment. Thus, the first update of the GINA guidelines defined asthma severity depending on the clinical features already proposed as well as the current treatment of the patient. In addition, severity is not a fixed feature of asthma, but may change over months or years, whereas the classification by severity suggests a static feature. Moreover, using severity as an outcome measure has limited value in predicting what treatment will be required and what the response to that treatment might be. Because of these considerations, the classification of asthma severity is no longer recommended as the basis for treatment decisions, a periodic assessment of asthma control being more relevant and useful.

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

“…In asthma, the control level is also independent of asthma medications (128)(129)(130)(131)(132). Although such an independent relationship was suspected in a study on allergic rhinitis (67), this very important finding was confirmed in a recent study in which it was found that the severity of rhinitis is independent of its treatment (119).…”

Important research questions in allergy and related diseases: nonallergic rhinitis: a GA2LEN paper

“…In some studies, it has been found that NAR is also associated with asthma (7,14,48). However, the importance of the association between the two sites of the airways needs to be better assessed comparing allergic and nonallergic patients, particularly in patients with uncontrolled asthma (49,50).…”

Asthma-related comorbidities

“…Asthma is of variable severity and is increasingly recognized as a condition presenting as various phenotypes [1,2]. Asthma control is the main goal of therapy and is achieved when the disease results in minimal or no symptoms, normal sleep and activities, and optimal pulmonary function [3,4]. Such control can be obtained with patient education, avoidance of environmental triggers, individualized pharmacotherapy and regular follow-up.…”