Control and severity: complementary approaches to asthma management

Control and severity: complementary approaches to asthma managementAssessment of asthma now relies on two concepts, namely control and severity.An influence of severity on asthmarelated costs has already been demonstrated (1).In the present issue of Allergy, Sullivan et al. show that, in a given severity stratum (i.e.patients with severe or difficultto-treat asthma), the degree of control is also a determinant of costs (2).This finding leads to consider conceptual and practical differences between control and severity.It can also stimulate discussions on what the goal of treatment should be, depending on the perspective. Control and severity: complementary approaches for asthma managementControl and severity are both based on symptoms, exacerbations, impact on daily life, use of rescue medications, lung function and its variations.Therefore, factor analysis has been unable to identify distinct constructs of these concepts (3), which both influence healthcare resource utilization (4, 5).However, each has specificities which drive their usage and interpretation.First, severity, but not control, takes into account daily maintenance therapy (Fig. 1) (6).This has significant practical implications, including the difficulty of determining the real level of severity in patients on maintenance treatment who are suspected of being noncompliant.In these patients, assessing and, if necessary, improving compliance with pharmacological prescriptions and environmental measures are the first step to improve asthma control (7) and allow reliable evaluation of severity.Besides, many primary care physicians find it difficult to use Global Initiative for Asthma (GINA) severity classification in routine practice and believe that such a static index is inappropriate for an inherently variable disease such as asthma (8).Accordingly, adherence to treatment guidelines remains relatively poor, in part, due to misclassification of severity (4, 5, 9-12).Therefore, some