Refractory asthma

Abstract

Morbidity of bronchial asthma and its sanitary costs are high. Although it is a disease characterized by a goal answer to the treatment, 5% of patients have a disease scarcely controllable defined "refractory asthma". For patient with severe persistent asthma, the Global Initiative for Asthma 2005 guidelines recommended high-dose inhaled corticosteroids in combination with a long acting β2-agonist, with one or more additional medications if required. However, recent studies have shown that asthma remains inadequately controlled in many patients with severe asthma despite treatment in accordance with guidelines. Patients with difficult to control asthma require a rigorous and systematic approach to their diagnosis and treatment. It is critical to make a diagnosis of asthma and to exclude other airways diseases and to identify possible correctable factors that may contribute to the poor control. Poor adherence to therapy is another common reason for a poor response. Treatment involves optimized corticosteroids inhaled therapy, associated additional drugs such as long acting ?2-agonists, leukotriene modifiers, sustained- release theophylline and oral corticosteroids.