Where are We Now In Moderate-to-Severe Asthma?
From Comprehensive Patient Evaluations to Individualized Evidence-based Care
Clinical Practice Guidelines
Global Strategy for Asthma Management and Prevention.
Global Initiative for Asthma, 2021.
GINA Guidance about COVID-19 and Asthma.
Global Initiative for Asthma, 2021.
Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline.
Holguin F, et al. Eur Respir J. 2020;55(1):1900588.
Clinical Practice Tools
Asthma Control Test (ACT)
This 5-item questionnaire helps evaluate asthma control in children aged 12 years or older. A score of <20 on the ACT suggests asthma that is uncontrolled.
Asthma Control Questionnaire (ACQ)
This 7-question assessment tool measures asthma control over the past 7 days. Six questions are self-administered by the patient, and 1 question requires a clinician’s input. Scores range from 1 (totally controlled) to 6 (severely uncontrolled).
Juniper EF, et al. Eur Respir J. 1999;14(4):902-907.
Asthma Therapy Assessment Questionnaire (ATAQ)
This 4-question test assesses asthma control over the past 4 weeks. Each question has a possible score of 0 or 1; if the sum of the 4 question scores is >1, the patient’s asthma may be uncontrolled.
Vollmer WM, et al. Am J Respir Crit Care Med. 1999;160(5 Pt 1):1647-1652.
Clinical Tools to Assess Asthma Control in Children
Dinakar C, et al. Pediatrics. 2017:139(1):e20163438.
Centers for Disease Control and Prevention (CDC) Asthma Action Plans
These tools for asthma control were created following the evidence-based guidance published by the National Institutes of Health.
American Academy of Pediatrics (AAP) Asthma Action Plan aged 0 to 5 years
These asthma action plans have been developed for children aged 0 to 5 years
American Academy of Pediatrics (AAP) Asthma Action Plan ≥6 years
These asthma action plans have been developed for children ≥6 years.
Shared Decision-Making Tool
The CHEST Foundation, Allergy and Asthma Network, and American College of Allergy, Asthma & Immunology (ACAAI) have developed a shared-decision making tool for adults with severe asthma so that they may work collaboratively with clinicians to improve self-management skills, choose the best treatment plan, and increase adherence.
Proper Inhaler Technique Demonstration Videos
Developed by the American Lung Association, these video tutorials may serve as a valuable resource to patients and caregivers, teaching the correct way to use multiple types of inhaler devices.
Clinical Practice Guidelines
Global Strategy for Asthma Management and Prevention.
Global Initiative for Asthma, 2021.
Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline.
Holguin F, et al. Eur Respir J. 2020;55(1):1900588.
Clinical Practice Tools
Clinical tools to assess asthma control in children.
Dinakar C, et al. Pediatrics. 2017:139(1):e20163438.
Assessing Asthma Control and Adjusting Therapy in Children.
The National Asthma Education and Prevention Program Expert Panel Report provides a stepwise approach to the assessment of asthma control in children as well as in adolescents within their 2007 Full Report (Figures 12-15).
Assessing Asthma Control and Adjusting Therapy in Children
The National Asthma Education and Prevention Program Expert Panel Report provides a stepwise approach to the assessment of asthma control in children as well as in adolescents within their 2007 Full Report (Figures 12-15).
Childhood Asthma Control Test (C-ACT)
This questionnaire includes 4 pictorial items and 3 verbal items and is appropriate for helping to assess asthma control in children 4 to 11 years old. A score of <19 on the C-ACT suggests asthma that is uncontrolled.
Asthma Control Test (ACT)
This 5-item questionnaire helps evaluate asthma control in children aged 12 years or older. A score of <20 on the ACT suggests asthma that is uncontrolled.
Asthma Control Questionnaire (ACQ-6)
This 6-item questionnaire helps assess asthma control in children aged 6 to 16 years and has a recall window of 1 week. Scores range from 1 (totally controlled) to 6 (severely uncontrolled).
Juniper EF, et al. Eur Respir J. 2010;36(6):1410-1416
Test for Respiratory and Asthma Control in Kids (TRACK)
This 5-item questionnaire helps assess asthma control in children 0 to 5 years old. A score <80 is suggestive of asthma that is uncontrolled.
American Academy of Pediatrics (AAP) Asthma Action Plan aged 0 to 5 years
These asthma action plans have been developed for children aged 0 to 5 years
American Academy of Pediatrics (AAP) Asthma Action Plan ≥6 years
These asthma action plans have been developed for children ≥6 years.
Clinical Practice Guidelines
Global Strategy for Asthma Management and Prevention.
Global Initiative for Asthma, 2021.
Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline.
Holguin F, et al. Eur Respir J. 2020;55(1):1900588.
Patient Advocacy Organizations and Resources
American Academy of Pediatrics (AAP)
AAP’s healthychildren.org website is powered by pediatricians and is a trusted resource for parents of children with asthma and allergies. Resources include useful tips from pediatricians on mitigating triggers, evolving information on asthma therapies, patient education videos centered around the proper use of medication devices, and much more.
Asthma and Allergy Foundation of America (AAFA)
AAFA is dedicated to improving the quality of life for people with asthma and allergic diseases through education, advocacy, and research.
American College of Allergy, Asthma & Immunology (ACAAI)
The ACAAI fosters a culture of collaboration and congeniality in which members work toward the common goals of patient care, education, advocacy, and research.
American Lung Association
The American Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease through education, advocacy, and research..
American Thoracic Society (ATS)
The mission of the ATS is to improve health worldwide by advancing research, clinical care, and public health in respiratory disease, critical illness, and sleep disorders.
Chest Foundation
The CHEST Foundation creates trusted patient education resources and disease awareness campaigns that empower patients to engage in better managing their health.
Suggested Readings
Understanding asthma phenotypes, endotypes, and mechanisms of disease.
Kuruvilla ME, et al. Clin Rev Allergy Immunol. 2019;56(2): 219-233.
Predictive biomarkers for asthma therapy.
Medrek SK, et al. Curr Allergy Asthma Rep. 2017;17(10):69.
Co-morbidities in severe asthma: clinical impact and management.
Porsbjerg C, Menzies-Gow A. Respirology. 2017;22(4):651-661.
Oral corticosteroid exposure and adverse effects in asthmatic patients.
Sullivan PW, et al. J Allergy Clin Immunol. 2018;141(1):110-116.e7.
New targeted therapies for uncontrolled asthma.
Sullivan PW, et al. J Allergy Clin Immunol. 2018;141(1):110-116.e7. Corren J. J Allergy Clin Immunol Pract. 2019;7(5):1394-1403
Which child with asthma is a candidate for biological therapies?
Bush A. J Clin Med. 2020;9(4):1237.
Omalizumab for the treatment of exacerbations in children with inadequately controlled allergic (IgE-mediated) asthma.
Lanier B, et al. J Allergy Clin Immunol. 2009;124(6):1210-1216.
Long-term safety and pharmacodynamics of mepolizumab in children with severe asthma with an eosinophilic phenotype.
Gupta A, et al. J Allergy Clin Immunol. 2019;144(5):1336-1342.e7.
Predictors of enhanced response with benralizumab for patients with severe asthma: pooled analysis of the SIROCCO and CALIMA studies.
FitzGerald JM, et al. Lancet Respir Med. 2018;6(1):51-64.
Dupilumab efficacy and safety in moderate-to-severe uncontrolled asthma.
Castro M, et al. N Engl J Med. 2018;378(26):2486-2496.
Dupilumab efficacy and safety in children with uncontrolled, moderate-to-severe asthma: the phase 3 VOYAGE study.
Bacharier LB, et al. ATS 2021. Abstract A1204.
Mepolizumab treatment in patients with severe eosinophilic asthma.
Ortega HG, et al. N Engl J Med. 2014;371(13):1198-1207.
Efficacy and safety of tezepelumab in adults and adolocesents with severe, uncontrolled asthma: results the phase 3 NAVIGATOR study.
Menzies-Gow A, et al J Allergy Clin Immunol.2021;147(2):AB249.
Reslizumab for inadequately controlled asthma with elevated blood eosinophil counts: results from two multicentre, parallel, double-blind, randomised, placebo-controlled, phase 3 trials.
Castro M, et al. Lancet Respir Med. 2015;3(5):355-366.
Tezepelumab in adults with uncontrolled asthma.
Corren J, et al. N Engl J Med. 2017;377(10):936-946
Doctor-patient communication: a review.
Ha JF, Longnecker N. Ochsner J. 2010; 10(1): 38-43.
Module 4
Relevant Resources
Differential Diagnosis and Comprehensive Management Strategies
Optimizing Maintenance Therapy Across Healthcare Settings
Improving Outcomes for Patients with COPD
Collaborative Approaches to Guideline-Concordant Patient Care
New Strategies for Individualizing Long-term Care
A New Era in Precision Medicine
Evolving Best Practices to Optimize Outcomes
Consensus and Controversies on the Road to Precision Medicine
Ongoing Monitoring, Pulmonary Rehabilitation, and Individualized Care
Debates and Discussions About Personalizing Patient Management
Differential Diagnosis, Multidisciplinary Management, and Patient Engagement
From Guideline Recommendations to Daily Clinical Decision-Making
Improving Patient Outcomes Through Shared Clinical Decision Making
Improving Patient Outcomes Through Shared Clinical Decision Making
Digging Deep on Shared Decision-Making
Clinical Resource Center
A Case-Based Conversation on Managing Asthma and Chronic Rhinosinusitis With Nasal Polyposis
The Clinical and Utilization Benefits of Exacerbation Prevention
Mechanistic Insights and Emerging Treatment Options
A Focus on Exacerbation Prevention
Best Practices for Primary Care
Evolving Best Practices for Patient Management
Shared Decision-making in the Era of Biologics
New Pathways to Patient Management
Preventing COPD Exacerbations to Improve Outcomes
A Whole Patient Case Series
Debates and Discussions about Monoclonal Antibody Therapies
An Update on Monoclonal Antibody Therapies
New Avenues to the Management of Severe Asthma
Evolving Best Practices for Pediatric Patients
Interdisciplinary Strategies for Adult and Pediatric Patients
Interdisciplinary Management of Eosinophilic Esophagitis and Hereditary Angioedema
Reducing LDL-C and a Lifetime of Cardiovascular Risk
A Multidisciplinary Look at Early Diagnosis and Management
Finding the Path in Chronic Rhinosinusitis with Nasal Polyps
Recent Developments in Anti-SARS-CoV-2 Monoclonal Antibodies for Treatment
Best Practices for Diagnosis and Management
New Avenues to Pre-Exposure Prophylaxis
New Pathways to Optimize Patient Outcomes
Debates and Discussions About New Upstream Treatment Avenues
A Case-Based Update on Pediatric Patients
