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Diagnosis, severity and control  

Diagnosing severe asthma is not always straightforward 

Identifying severe asthma can be problematic. It is important to differentiate between severity and control: as mild asthma can be poorly controlled, and severe asthma can be well controlled. 1-2

Patients may also present with asthma that is difficult to treat. Although both difficult-to-treat asthma and severe refractory asthma could present with severe symptoms and poor control, they are different conditions with different underlying causes. 3

Difficult-to-treat asthma can have multiple confounding factors that complicate diagnosis, such as comorbidities or poor adherence to medication. 3Severe asthma can only be diagnosed once difficult-to-treat asthma has been excluded. 3-4 The recent recommendations by the ATS/ERS Task Force suggest that a patient presenting with difficult-to-treat asthma has their asthma diagnosis confirmed, evaluated and managed by an asthma specialist for more than 3 months4After addressing confounding factors, patients remaining refractory and requiring a second inhaled controller and/or OCS can be diagnosed with severe asthma. 4


  1. GINA 2016 © 2016 Global Initiative for Asthma, all rights reserved.  Use is by express license from the owner. www.ginasthma.org (Last accessed December 2016).
  2. Peters SP, et al. Respir Med 2006;100:1139–51.
  3. Bel EH, et al. Thorax 2011;66:910–7
  4. Chung KF, et al. Eur Respir J 2014;43:343–73.