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Review
. 2010;65(9):905-18.
doi: 10.1590/s1807-59322010000900014.

Difficult-to-control asthma management through the use of a specific protocol

Pedro Giavina-Bianchi  1 , Marcelo Vivolo Aun, Carla Bisaccioni, Rosana Agondi, Jorge Kalil
Affiliations
Review

Difficult-to-control asthma management through the use of a specific protocol

Pedro Giavina-Bianchi et al. Clinics (Sao Paulo). 2010.

Abstract

The present study is a critical review of difficult-to-control asthma, highlighting the characteristics and severity of the disease. It also presents a protocol for the management of patients with this asthma phenotype. The protocol, which was based on relevant studies in the literature, is described and analyzed.

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Figures

Figure 1
Figure 1
Hospitalization due to asthma in Brazil as a whole and in São Paulo, Brazil in particular, according to data from the Information Technology Department of the Brazilian Unified Health Care System.‐ Hospitalization due to asthma in Brazil as a whole and in São Paulo, Brazil in particular, according to data from the Information Technology Department of the Brazilian Unified Health Care System. IC: inhaled corticosteroid; LABA: long‐acting β2 agonist
Figure 2
Figure 2
Protocol for the treatment of patients with difficult‐to‐control asthma.‐ Protocol for the treatment of patients with difficult‐to‐control asthma. VCD: vocal cord dysfunction; ABPA: allergic bronchopulmonary aspergillosis; NSAIDs: nonsteroidal anti‐inflammatory drugs; CSS: Churg‐Strauss syndrome
Figure 3
Figure 3
Description of levels of evidence (Adapted from GINA).‐ Description of levels of evidence (Adapted from GINA).
Figure 4
Figure 4
Criteria for the diagnosis of difficult‐to‐control asthma.‐ Criteria for the diagnosis of difficult‐to‐control asthma. SC: systemic corticosteroid; IC: inhaled corticosteroid; LABA: long‐acting β2 agonist; FEV1: forced expiratory volume in one second; PEF: peak expiratory flow; PFT: pulmonary function test
Figure 5
Figure 5
Assessment of asthma control.‐ Assessment of asthma control. FEV1: forced expiratory volume in one second; PEF: peak expiratory flow; ACT: asthma control test; ACQ: asthma control questionnaire; ATAQ: asthma therapy assessment questionnaire; ACSS: asthma control scoring system; AQLQ: asthma quality of life questionnaire
Figure 6
Figure 6
Questionnaires to measure asthma control.‐ Questionnaires to measure asthma control. ACT: asthma control test; ACQ: asthma control questionnaire; ATAQ: asthma therapy assessment questionnaire; ACSS: asthma control scoring system; FEV1: forced expiratory volume in one second; PEF: peak expiratory flow; and %ES: percentage of eosinophils in sputum; ND: not determined
Figure 7
Figure 7
Differences between allergic asthma and non‐allergic asthma.‐ Differences between allergic asthma and non‐allergic asthma. NSAID: nonsteroidal anti‐inflammatory drug; IgE: immunoglobulin E
Figure 8
Figure 8
Rate of severe exacerbations of asthma in the last year.‐ Rate of severe exacerbations of asthma in the last year.
Figure 9
Figure 9
Objectives of the Allergic Rhinitis and its Impact on Asthma initiative.‐ Objectives of the Allergic Rhinitis and its Impact on Asthma initiative.
Figure 10
Figure 10
Pathophysiological evidence for the interaction between allergic rhinitis and allergic asthma.‐ Pathophysiological evidence for the interaction between allergic rhinitis and allergic asthma.
Figure 11
Figure 11
Specific questionnaire for the clinical suspicion of vocal cord dysfunction.‐ Specific questionnaire for the clinical suspicion of vocal cord dysfunction. Q: question;FEV1: forced expiratory volume in one second; and PEF: peak expiratory flow
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