title: Can severe asthmatic patients achieve asthma control? A systematic approach in patients with difficult to control asthma followed in a specialized clinic.
abstract: Despite advances in asthma treatment, severe asthma (SA) still results in high morbidity and use of health resources. Our hypothesis was that SA patients would achieve adequate control with a systematic protocol, including oral corticosteroids, budesonide/formoterol maintenance and reliever therapy and a multidisciplinary approach to improve adherence.
  
  
  
  Non-controlled (NC) SA patients were enrolled to receive 2 weeks of oral corticosteroids and 12 weeks of formoterol + budesonide. Assessments included asthma control questionnaire (ACQ), asthma control test (ACT), daily symptom diary, lung function and health-related quality of life (HRQoL) questionnaires.
  
  
  
  Of 51 patients, 13 (25.5%) achieved control. NC patients had higher utilization of health resources and higher exacerbation rates. Both controlled (C) and NC patients had significantly reduced ACQ scores after oral corticosteroid treatment. After 12 weeks, C patients continued improving. NC patients did not have significant changes. A similar pattern was found regarding lung function, use of rescue medication, and days free of symptoms. After 2 weeks of oral corticosteroids, an increase occurred in those who achieved the ACQ cut off; however, 53.8% of C patients had an ACQ < 1.57 versus 21.1% of NC patients (p = 0.03). Both groups had low HRQoL at baseline with improvement after intervention.
  
  
  
  Despite rigorous, optimized follow-up treatment, 75% of SA patients did not achieve adequate symptom control and presented with impaired quality of life. Conversely, application of a low-cost, easy to implement systematic protocol can prevent up to 25% of SA patients from up-titrating to new and complex therapies, thus reducing costs and morbidity.
  
  
  
  Retrospectively registered at ClinicalTrial.gov on 22 February 2010 ( NCT01089322 ).
authors.affiliation: Pulmonary Division - Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/BR, Av Dr Eneas de Carvalho Aguiar, 44 - 5° andar (Pneumologia), São Paulo, 05403-900, SP, Brazil. rathanazio@yahoo.com.br.
authors.forename: Rodrigo
authors.identifier: 0000-0002-9399-5275
authors.initials: R
authors.lastname: Athanazio
authors.affiliation: Pulmonary Division - Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/BR, Av Dr Eneas de Carvalho Aguiar, 44 - 5° andar (Pneumologia), São Paulo, 05403-900, SP, Brazil.
authors.forename: Regina
authors.initials: R
authors.lastname: Carvalho-Pinto
authors.affiliation: Pulmonary Division - Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/BR, Av Dr Eneas de Carvalho Aguiar, 44 - 5° andar (Pneumologia), São Paulo, 05403-900, SP, Brazil.
authors.forename: Frederico Leon Arrabal
authors.initials: FL
authors.lastname: Fernandes
authors.affiliation: Pulmonary Division - Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/BR, Av Dr Eneas de Carvalho Aguiar, 44 - 5° andar (Pneumologia), São Paulo, 05403-900, SP, Brazil.
authors.forename: Samia
authors.initials: S
authors.lastname: Rached
authors.affiliation: Lungen Clinic Grosshansdorf and Department of Medicine, Christian Albrechts University Kiel, Airway Research Center North (ARCN) in the German Center for Lung Research (DZL), Kiel, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Rabe
authors.affiliation: Pulmonary Division - Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/BR, Av Dr Eneas de Carvalho Aguiar, 44 - 5° andar (Pneumologia), São Paulo, 05403-900, SP, Brazil.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cukier
authors.affiliation: Pulmonary Division - Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/BR, Av Dr Eneas de Carvalho Aguiar, 44 - 5° andar (Pneumologia), São Paulo, 05403-900, SP, Brazil.
authors.forename: Rafael
authors.initials: R
authors.lastname: Stelmach
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D001938:Brazil; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D019819:Budesonide / Q000008:administration & dosage*; D005260:Female; D000068759:Formoterol Fumarate / Q000008:administration & dosage*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011788:Quality of Life; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D019819:Budesonide; D000068759:Formoterol Fumarate
keywords: Asthma; Control; Difficult to control; Health related quality of life; Refractory asthma