Unifying Concepts

Diagnostic Criteria for Difficult-to-Control Asthma

The difficult-to-control asthma can be defined as that which is inadequately or poorly controlled despite an appropriate therapeutic strategy that is adjusted to clinical severity.

Diagnostic Criteria for Difficult-to-Control Asthma
A diagnosis of difficult-to-control asthma is established when, once false difficult-to-control asthma has been ruled out, 2 major criteria or 1 major and 2 minor criteria are met. Criteria are modified in part from the proposal of the American Thoracic Society Workshop on Refractory Asthma

Major criteria

  • Use of oral corticosteroids continuously or for more than 6 months in the last year
  • Continuous use of inhaled corticosteroids at high doses (budesonide or equivalent >1200 ug/day or fluticasone >880 ug/day) alongside another antiasthmatic drug, usually a long-acting B2-adrenergic (LABA)

Minor criteria

  • Daily requirement for short-acting B2-adrenergic (SABA) rescue medication
  • FEV1 less than 80% of theoretical value or greater than 20% variability of PEF
  • One or more visits to the emergency department in the last year
  • Three or more courses of oral corticosteroids in the last year
  • Prior episode of life-threatening asthma
  • Rapid deterioration of lung function

*FEV1 indicates forced expiratory volume in the first second; PEF, peak expiratory flow.



  1. López-Viña A, Agüero-Balbín R, Aller-Alvarez JL, Bazús-González T, Cosio BG, de Diego-Damiá A, Martínez-Moragón E, Pereira-Vega A, Plaza-Moral V, Rodríguez-Trigo G, Villa-Asensi JR; Area de Asma-SEPAR. Guidelines for the diagnosis and management of difficult-to-control asthma. Arch Bronconeumol. 2005 Sep;41(9):513-23. [Medline]
  2. Le AV, Simon RA. The Difficult-to-Control Asthmatic: A Systematic Approach. Allergy Asthma Clin Immunol. 2006 Sep 15;2(3):109-16. [Medline]


Created Aug 27, 2012.

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