Uncontrolled asthma: what is behind it?

Abstract

Authors describe the clinical features and causes of severe uncontrolled asthma. Algorithm of evaluation of the patient with persisting clinical symptoms receiving treatment with the highest doses of inhaled corticosteroids in combination with long-acting β­-agonists and/or systemic corticosteroids, should include: a preliminary exclusion of an alternative diagnosis, eliminating the influence of concomitant diseases, preventing exposure to trigger factors, achieving high adherence to prescribed treatment, improving the inhalation techniques. Further steps on the path of regaining control should be aimed at determining phenotype of asthma. Difficulties in achieving control can be expected in patients with severe atopic asthma, late-onset persistent eosinophilic asthma, obesity-related severe nonatopic asthma, neutrophilic asthma.