From the Guidelines
Asthma control is defined by the absence or minimal presence of symptoms, normal lung function, and the ability to engage in daily activities without limitations, as stated in the most recent guidelines 1. This definition involves assessing both current symptom control and future risk of adverse outcomes.
- Good asthma control means having daytime symptoms no more than twice weekly,
- no nighttime awakenings due to asthma,
- reliever medication needed no more than twice weekly, and
- no activity limitations. Lung function tests should show FEV1 or peak flow at or above 80% of predicted values with minimal variability. Additionally, well-controlled asthma includes having no exacerbations requiring oral corticosteroids, emergency visits, or hospitalizations in the past year. Patients should monitor their symptoms using validated tools like the Asthma Control Test (ACT) or Asthma Control Questionnaire (ACQ), which provide standardized scores to determine control levels, as recommended by the American Thoracic Society and European Respiratory Society 1. Regular assessment is crucial as asthma control can fluctuate over time, requiring medication adjustments, and the goal of asthma management is to achieve and maintain control while minimizing medication side effects and addressing modifiable risk factors like smoking, allergen exposure, and poor inhaler technique, as emphasized in the National Asthma Education and Prevention Program’s Expert Panel Report 3 (EPR-3) 1.
The assessment of asthma control should include components relevant to both current symptom control and future risk of adverse outcomes, as highlighted in the American Journal of Respiratory and Critical Care Medicine 1.
- The level of asthma control will guide decisions either to maintain or to adjust therapy,
- and the emphasis for clinical management is to assess asthma severity before initiating therapy and then to assess asthma control for monitoring and adjusting therapy, as stated in the Journal of Allergy and Clinical Immunology 1. Asthma severity and control include the domains of current impairment and future risk, and the specific measures used to assess severity and control are similar, including symptoms, use of SABAs for quick relief of symptoms, limitations to normal activities because of asthma, pulmonary function, and exacerbations, as noted in the Mayo Clinic Proceedings 1.
Overall, achieving optimal asthma control requires a comprehensive approach that takes into account the complex nature of the disease, the importance of patient education and self-management, and the need for regular assessment and adjustment of therapy, as concluded in the American Journal of Respiratory and Critical Care Medicine 1.
From the Research
Definition of Asthma Control
Asthma control is defined by the absence of daytime symptoms, nighttime waking, reliever use, functional limitation, and lung function stability, and to also reduce the future risks of asthma exacerbations, deterioration in lung function, and the medication's adverse effects 2.
Components of Asthma Control
The assessment of asthma control should incorporate the dual components of:
- Current clinical control (e.g. symptoms, reliever use and lung function)
- Future risk (e.g. exacerbations and lung function decline) 3
Factors Influencing Asthma Control
Asthma control can be influenced by the underlying disease activity and by the patient's phenotype, both of which may be further described using pathological and physiological markers 3.
Treatment Options for Achieving Asthma Control
Treatment options for achieving asthma control include:
- Inhaled corticosteroids (ICS) alone 4, 5
- Combination of ICS and long-acting beta-agonists (LABA) 2, 4, 6
- Combination of ICS and LABA as a single combination maintenance and reliever inhaler 2, 4
Key Considerations
Key considerations for achieving asthma control include: