title: Factors leading to refractory asthma in patients from Saudi Arabia.
abstract: OBJECTIVE
  The aim of this study was to study the clinical characteristic of patient with refractory asthma (RA) from Saudi Arabia.
  
  
  METHODS
  This paper prospectively studied in a university hospital factors leading to RA in a cohort of patients who have inadequately controlled asthma or with frequent exacerbations despite optimum controller therapy. It also studied patients with asthma that requires extended periods of oral steroids to control.
  
  
  RESULTS
  The mean age was 45.1 years (±9.1) where 74 patients were enrolled in this study with the age group (37-48 years) is having the highest percentage (64.8%). Female patients represented 62.2%. The two major comorbid conditions were allergic rhinitis (54.1%) and gastroesophageal reflux (33.8%). The vast majority (72 patients) had at least one trigger factor for asthma (97.3%). The asthma control test showed that 86.4% had an uncontrolled status. Spirometry showed mild disease in 9.5%, moderate in 47.3%, and severe in 43.2%. Eosinophilia was seen in only 16.2%. Immunoglobulin E level between 70 and 700 μg/L was found in 58.1% of patients.
  
  
  CONCLUSIONS
  RA has certain clinical characteristics and associated comorbid conditions as well as precipitating factors that facilitate the identifications of these cases.
authors.affiliation: Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
authors.forename: Amal M
authors.initials: AM
authors.lastname: Al-Moamary
authors.affiliation: Department of Medicine, College of Medicine, University of Sharjah, Sharjah, UAE.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Al-Hajjaj
authors.affiliation: Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Al Moamary
keywords: Asthma; Saudi Arabia; difficult-to-treat asthma; refractory asthma