Asthma – from severity to control. The methods of asthma control assessment
Joanna Mikołajczyk1, Iwona Grzelewska-Rzymowska1,2, Jadwiga Kroczyńska-Bednarek1,2
According to the first asthma management guidelines, treatment of asthma depends on its severity define by clinical symptoms and lung function parameters. In fact, asthma is a variable disease and might change over time, which highlights the need for patient’s clinical condition assessment continuously and for medication adjustment. However, asthma severity level does not flexibly reflect the response to treatment. Therefore, current statement of world expert recommends a change in approach to asthma management and submits achieving asthma control over establishment its severity, distinguishing totally controlled asthma, partially controlled and uncontrolled asthma. GINA 2006 formulates achieving optimal asthma control status of disease as the main goal of asthma treatment. Asthma control refers to the degree to which symptoms of asthma are minimised by therapeutic intervention and it is better if concerns also pathological and physiological markers. According to updated assumptions, the definition of asthma control level is the basis of choosing and modification of asthma pharmacotherapy. Accurate assessment of asthma control improves effectiveness of treatment. Several methods are available to specifically assess asthma control, including assessment of clinical parameters (daytime and nocturnal symptoms, bronchodilator intake), lung function (PEF and FEV1), underlying airway inflammation (bronchial hyper-responsiveness, induced sputum eosinophilia, exhaled nitric oxide concentration). Subjective methods are also available such as questionnaires or short asthma control tests (ACT, ACQ, ATAQ). Currently there is no clear statement which parameters or its combination could be considered as the most reliable tool of asthma control assessment. According to multidimensional pathogenesis of asthma, to get asthma control full picture it seems to be sensible to connect objective and subjective parameters.