3/2007Severe and difficult asthma

GRAŻYNA BOCHENEK (Klinika Pulmonologii, II Katedra Chorób Wewnętrznych Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie;Kierownik: prof. dr hab. med. Ewa Niżankowska-Mogilnicka)

Summary
Severe and difficult asthma makes a serious health problem. According to GINA, this type of asthma is diagnosed in patients in whom the disease is not controlled despite the treatment at the level 4, i.e. by using high doses of inhaled corticosteroids together with long acting ß2-mimetics and at least one additional controller medication (antileukotrienes or methylxanthines). It is estimated that patients with severe and difficult asthma make about 5% of all asthmatics. In this group of patients asthma symptoms persist, exacerbations are frequent, long acting ß2-mimetics are used very often, physical activity is limited, despite optimal treatment. To recognize that the patient has severe and difficult asthma, he has to be observed for at least 6 months. During this time the patient should be optimally treated, according to actual guidelines, and all factors responsible for bad asthma control should be ruled out. Differential diagnosis with other diseases mimicking asthma should be also performed. In the paper all these factors and diseases are discussed. One should remember that inappropriate treatment and incorrect technique of inhalations are the main factors responsible for bad asthma control. Therefore, the doctor is obliged to check the compliance and proper technique of inhalation in patients with uncontrolled asthma. To take care of patients with severe and difficult asthma is very challenging. Therefore these patients should be treated by allergologists and pulmonologists. The more so as severe asthma is not a homogenous disease. Different clinical phenotypes of the disease are also discussed.

Key words: severe asthma, difficult asthma, asthma control