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Consensus Document on the Diagnosis of Severe Uncontrolled Asthma


P Barranco,1 C Pérez-Francés,2 S Quirce,1 E Gómez-Torrijos,3 R Cárdenas,3 S Sánchez-García,4 F Rodríguez-Fernández,5 P Campo,6 JM Olaguibel,7 J Delgado8
Severe Asthma Working Group of the SEAIC Asthma Committee

1Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
2Department of Allergy, Hospital Universitario Dr. Peset, Valencia, Spain
3Department of Allergy, Hospital General de Ciudad Real, Ciudad Real, Spain
4Section of Allergy, Hospital Infantil Universitario del Niño Jesús, Madrid, Spain
5Department of Allergy, Hospital Universitario Marqués de Valdecilla, Santander, Spain
6Unidad de Gestión Clínica de Alergología, Hospital Carlos Haya, Málaga, Spain
7Department of Allergy, Complejo Hospitalario de Navarra, Pamplona, Spain
8Unidad de Gestión Clínica de Alergología, Hospital Virgen Macarena, Sevilla, Spain

J Investig Allergol Clin Immunol 2012; Vol. 22(7): 460-475



Background: The concepts of asthma severity, control, and exacerbation are important in the evaluation of patients and their response to treatment. However, terminology is not standardized, and terms are often used interchangeably. Patients with uncontrolled severe asthma pose a major health care problem. Over the last decade, it has become increasingly clear that, in order to facilitate the development of novel targeted therapies, patients must be further characterized and classified.

Objective: To draft a consensus statement on the diagnosis, management, and treatment of severe uncontrolled asthma. The statement is meant to serve as a guideline for health professionals and clinical researchers.

Methods: The consensus was led by the Severe Asthma Working Group of the Spanish Society of Allergology and Clinical Immunology Asthma Committee. A review was conducted of the best available scientific evidence (until December 2011) on severe asthma in adults and children.

Results: Definitions for severe asthma, level of control, and exacerbation are developed. Different phenotypes and endophenotypes of severe uncontrolled asthma and new specific therapeutic interventions are presented. A systematic algorithm for the evaluation of patients presenting with severe persistent asthma symptoms is proposed.

Conclusions: A consensus statement on the diagnosis, management, and treatment of severe uncontrolled asthma is presented.

Key words: Asthma. Severity. Control. Exacerbations. Algorithm.