“Severe-controlled” asthma 4 years later: is it still controlled?

Shabtai Varsano*, Lilach Israeli, David Shitrit

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Controlled severe asthma is based on needing regular medication and 4 markers of good asthma control. This study reevaluated a community sample defined 4 years earlier as “severe-controlled” based on electronic medical records of medications dispensed over 12 months. Objectives: Determine the current extent of clinically-controlled asthma and asthma-related quality-of-life among patients previously considered “severe-controlled”. Methods: 69 patients considered “severe-controlled” 4 years earlier answered a questionnaire that included the asthma control test (ACT), demographics, education, comorbidities, medications, asthma-related healthcare utilization, atopy history, environmental exposures, and follow-up. Patients underwent spirometry, eosinophil count, total IgE, and skin–prick testing for airborne allergens. Results: Ninety-seven percent reported using combined inhalers (ICS + LABA) regularly. Only 4% visited the ER and none was hospitalized in the last year. Average predicted FEV1 was 80%. Average ACT score was 19; 51% reported recurrent heartburn, 46% night awakenings and 70% recurrent rhinitis. Skin–prick testing was positive in 72%, average IgE was 376 IU/ml. Eosinophil counts were ≥300/ml in 42% and ≥400/ml in 25%. ACT < 20 was strongly related to recurrent heartburn. Formal education was related to ACT ≥ 20 (p = 0.045) and perception of good asthma control the previous month (p < 0.001). Eosinophil count, recurrent heartburn, total IgE, and recurrent rhinitis were interrelated. Conclusions: Among severe asthmatics, good drug compliance, low use of relievers and low rates of exacerbations do not necessarily reflect asthma-related quality-of-life and optimal control. We urge physicians and HMOs to address asthma control in terms of quality-of-life based on validated questionnaires, and offer all patients asthma education; perhaps more to those with low formal education.

Original languageEnglish
Pages (from-to)1102-1110
Number of pages9
JournalJournal of Asthma
Issue number8
StatePublished - 2021


  • Severe asthma
  • asthma control test (ACT)
  • eosinophils
  • heartburn
  • severe controlled asthma
  • subjective perception
  • total IgE


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