Article

A new perspective on concepts of asthma severity and control.

Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand.
European Respiratory Journal (impact factor: 5.89). 10/2008; 32(3):545-54. DOI:10.1183/09031936.00155307 pp.545-54
Source: PubMed

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) high-intensity 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.

0 0
 · 
0 Bookmarks
 · 
24 Views
  • Source
    Article: Identification and management of adults with asthma prone to exacerbations: can we do better?
    Neil C Thomson, Rekha Chaudhuri
    [show abstract] [hide abstract]
    ABSTRACT: Exacerbations are a major cause of morbidity in asthma and generate high health costs. Identification and management of adults with asthma who are prone to exacerbations is of considerable importance as by this means it should be possible to reduce the number of patients who currently experience inadequately controlled disease. Exacerbations occur most frequently in individuals with severe disease. Other risk factors include a history of a recent exacerbation, co-morbidities such as a raised body mass index and psychological problems as well as current smoking and lower socio-economic status. A low FEV1, particularly if combined with the additional information from questionnaires helps predict exacerbations. Despite the association between these risk factors and exacerbations it remains difficult to accurately predict in an individual patient with asthma whether they will go on to develop an exacerbation in the future. A major aim of international guidelines on the management of asthma is to prevent future risks of exacerbations, but some patients, particularly those with severe disease, respond poorly to current therapies and continue to experience recurrent exacerbations. There is an unmet need for improved management strategies and drugs targeted at preventing asthma exacerbations. Monitoring induced sputum eosinophil cell counts is helpful in preventing exacerbations in some patient with severe asthma. Future developments are likely to include the identification of better biomarkers to predict exacerbations or the cause of exacerbations, augmentation of the immunological response to viruses at the time of the exacerbation, the use of telemonitoring in patients with severe asthma and the development of improved therapies targeted at reducing exacerbations.
    BMC Pulmonary Medicine 01/2009; 8:27. · 1.33 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

American Thoracic Society/European Respiratory Society Task Force
 
Asthma control
 
asthma guidelines
 
asthma phenotype
 
Asthma severity
 
clinically useful concept
 
Concepts
 
current clinical control
 
current concepts
 
dual components
 
good asthma control
 
lung function
 
lung function decline
 
pathological
 
patient's phenotype
 
physiological markers
 
reliever use
 
separate concepts
 
Severe asthma
 
underlying disease activity
 

D R Taylor