Considerations in difficult-to-control asthma.
BACKGROUND
Difficult-to-control asthma includes those patients who require treatment with high-dose inhaled glucocorticosteroid (ICS) plus a second controller and/or systemic glucocorticosteroids to manage. The exact percentage of "difficult to treat," "refractory," "severe," or "brittle" asthma is 3% to 10% of all asthmatic patients, but this group of asthmatics use the majority of resources for the entire asthmatic population.


METHODS
Medline searches for the terms "difficult to control," "severe," "refractory," "brittle," and asthma were done and the results were reviewed.


RESULTS
Patterns for difficult-to-control asthma emerge from concepts of compliance, comorbidity, and endotypes, which give the practitioner pathways for analyzing this subset of asthma patients.


CONCLUSIONS
The ear, nose, and throat (ENT) physician can be of significant help to other asthma specialists in the recognition of the difficult-to-control asthmatic, as well as providing specific specialized diagnostic skills and the reinforcement of adherence to medical regimens.
Immunology and Respiratory Consultants, Ft. Worth, TX.
Bob Q
BQ
Lanier
Immunology and Respiratory Consultants, Ft. Worth, TX.
Millard
M
Tierce
D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D005764:Gastroesophageal Reflux / Q000175:diagnosis; D006801:Humans; D010349:Patient Compliance; D011602:Psychophysiologic Disorders / Q000175:diagnosis; D016896:Treatment Outcome; D064706:Vocal Cord Dysfunction / Q000175:diagnosis
D018927:Anti-Asthmatic Agents
Asthma-refractory; QOL; brittle; difficult to treat; severe