Consensus document on the diagnosis of severe uncontrolled asthma.

BACKGROUND The concepts of asthma severity, control, and exacerbation are important in the evaluation of patients and their response to treatment. However, terminology is not standardized, and terms are often used interchangeably. Patients with uncontrolled severe asthma pose a major health care problem. Over the last decade, it has become increasingly clear that, in order to facilitate the development of novel targeted therapies, patients must be further characterized and classified. OBJECTIVE To draft a consensus statement on the diagnosis, management, and treatment of severe uncontrolled asthma. The statement is meant to serve as a guideline for health professionals and clinical researchers. METHODS The consensus was led by the Severe Asthma Working Group of the Spanish Society of Allergology and Clinical ImmunologyAsthma Committee. A review was conducted of the best available scientific evidence (until December 2011) on severe asthma in adults and children. RESULTS Definitions for severe asthma, level of control, and exacerbation are developed. Different phenotypes and endophenotypes of severe uncontrolled asthma and new specific therapeutic interventions are presented. A systematic algorithm for the evaluation of patients presenting with severe persistent asthma symptoms is proposed. CONCLUSIONS A consensus statement on the diagnosis, management, and treatment of severe uncontrolled asthma is presented.