Severe Asthma: An Update for 2019

Adam D. Highley, MD; Craig Cookman, DO; Lee E. Morrow, MD, FCCP, ATSF; Mark A. Malesker, PharmD, FCCP, FCCP, FCCM, FASHP, BCPS


US Pharmacist. 2019;44(7):HS 2-HS 7. 

In This Article

Asthma Definitions

Since 2014, clinicians have made increasing efforts to distinguish asthma severity from asthma control.[2] Asthma control denotes the degree to which the clinical manifestations of asthma are minimized, and asthma severity alludes to the intrinsic intensity of the disease process. Severity and control are distinct entities, as one patient may have mild asthma that is treatment refractory and consequently poorly controlled, whereas another patient may have more severe asthma that is treatment responsive and well controlled.

All patients with asthma are at risk for acute exacerbations. A patient is said to have uncontrolled asthma if he or she has poor symptom control (frequent rescue-inhaler use, activities limited by asthma, nocturnal awakening due to asthma) or has frequent exacerbations (two or more courses of oral corticosteroids in 12 months, one or more asthma-related hospitalizations in 12 months).[5]

Asthma is considered difficult-to-treat if the patient remains uncontrolled despite compliance with medium-dose or high-dose inhaled corticosteroids in combination with a second controller; the patient requires oral corticosteroids to achieve control; or the patient remains uncontrolled despite oral corticosteroids.[2]

Severe asthma is a subset of difficult-to-treat asthma wherein the disease either remains uncontrolled despite treatment of contributing factors and adherence to maximally optimized therapy or worsens when high-intensity therapy is decreased.[2] Historically, severe asthma has been referred to as severe refractory asthma, asthma emergency, asthma attack, or status asthmaticus. Under current guidelines—and with the introduction of biological therapies—these terms are incorrect, inaccurate, or lacking in specificity.