Elsevier

Respiratory Medicine

Volume 98, Supplement 2, October 2004, Pages S16-S21
Respiratory Medicine

Tools to assess (and achieve?) long-term asthma control

https://doi.org/10.1016/j.rmed.2004.07.011Get rights and content
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Summary

Assessment tools are needed to monitor asthma control and to detect exacerbations before the alteration of functional parameters and the occurrence of symptoms. The ability to effectively monitor asthma control would enable clinicians to increase corticosteroid dose or to stop corticosteroid tapering before symptoms occur. As a few severe exacerbations are expected per year in treated patients, these tools must be suitable for long-term use. They must also be reproducible, acceptable to patients and be non-invasive. Tools currently available to assess asthma control include assessment of: clinical parameters (e.g. nocturnal awakenings; bronchodilator intake; symptom scores); lung function (e.g. peak expiratory flow and forced expiratory volume in 1 s); subjective parameters of asthma control (e.g. asthma control questionnaire (ACQ)); bronchial hyper-responsiveness; eosinophilia in induced sputum; and exhaled nitric oxide (NO) concentration. Clinical symptoms, lung function and the ACQ have proved to be inadequate markers of asthma control, as changes in these parameters occur at the same time as symptom manifestation. By contrast, sputum eosinophilia and exhaled NO concentrations are truly predictive of asthma exacerbations; monitoring these parameters are useful in preventing exacerbations from occurring in the first instance. They also assess, and help to achieve asthma control in the long term.

Keywords

Asthma control
Induced sputum
Eosinophilia
Exhaled NO
Bronchial hyperreactivity
Exacerbations

Abbreviations

ACD
asthma control diary
ACQ
asthma control questionnaire
AMP
adenosine monophosphate
BHR
bronchial hyper-responsiveness
BTS
British Thoracic Society
FEV1
forced expiratory volume in 1 s
ICS
inhaled corticosteroid
IS
induced sputum
LABA
long-acting β2-agonist
NO
nitric oxide
PEF
peak expiratory flow

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