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Defining asthma

Asthma is like an iceberg. Symptoms like breathlessness, coughing and a tight chest, as well as exacerbations, only represent the visible part of the problem.1,2

Although the symptoms that they can see and feel may be of most importance to your patients, the invisible symptoms that lie beneath the surface, such as bronchial hyperresponsiveness, chronic inflammation and airway remodelling, may be present.2

iceberg with visible and invisible symptoms of bad asthma control iceberg with visible and invisible symptoms of bad asthma control

Invisible symptoms and MART regimens

MART regimens rely on patient perceptions to control symptoms, but these are unreliable3 and do not address underlying inflammation. See how switching to Relvar can benefit patients controlled on a MART regimen.


GINA-defined asthma control

Achieving asthma control is the ultimate aim of treatment. In order to help define a patient’s level of asthma control, GINA has identified four key indicators as part of its control assessment.

In the past 4 weeks, has your patient had:

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Daytime asthma symptoms more than twice/week?

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Any night waking due to asthma?

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SABA reliever for symptoms more than twice/week?


Any activity Limitation due to asthma?

Each question requires a ‘yes’ or ‘no’ answer, scored as 1 or 0 respectively.

The composite score from this assessment then determines the patient’s level of asthma control:

  • 0 is considered well controlled
  • 1–2 is considered partly controlled
  • 3–4 is considered uncontrolled

The Asthma Control Test

For patients, the clinically-validated Asthma Control Test (ACT) is a useful way for them to better understand and improve their perception of asthma control.

The test is based on the four GINA indicators above, but also includes the patient’s perception of asthma control:

Shortness of breath due to asthma

All assessment questions refer to the previous 4 weeks and are answered with a score of 1 to 5.4,5

The composite score indicates the level of asthma control:

  • 5–15 is considered very poorly controlled
  • 15–20 is considered poorly controlled
  • 20–25 is considered well controlled

An improvement of 3 points is the minimal clinically important difference.4

The GINA guidelines define well controlled as no symptoms.1

Visit the ACT website, here.

Are your asthma patients’ symptoms really controlled?

Discover Relvar


ACT, Asthma Control Test; GINA, Global Initiative for Asthma; MART, maintenance and reliever therapy.

  1. GINA. Global strategy for asthma management and prevention. Available at: Accessed January 2024.
  2. Ishmael FT. J Am Osteopath Assoc 2011;111(11 Suppl. 7):S11–17.
  3. Chapman KR, et al. Thorax 2010;65:747–752.
  4. Asthma Control Test. Available at: Accessed January 2024.
  5. Schatz M, et al. J Allergy Clin Immunol 2009;124:719–723.e1.

RELVAR Ellipta was created in collaboration with

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Adverse events should be reported directly to the Health Products Regulatory Authority (HPRA) on their website: Adverse events should also be reported to GlaxoSmithKline on 1800 244 255.

Relvar is a registered trademark of the GlaxoSmithKline group of companies

PM-IE-FFV-WCNT-230006 January 2024