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Special Features: Asthma |

The Poorly Explored Impact of Uncontrolled AsthmaUncontrolled Asthma

Paul M. O’Byrne, MBBCh, FCCP; Søren Pedersen, MD; Michael Schatz, MD, FCCP; Anders Thoren, PhD; Ella Ekholm, PhD; Lars-Göran Carlsson, MD; William W. Busse, MD
Author and Funding Information

From the Firestone Institute of Respiratory Health (Dr O'Byrne), St. Joseph's Healthcare and Department of Medicine, McMaster University, Hamilton, ON, Canada; University of Southern Denmark (Dr Pedersen), Paediatric Research Unit, Kolding Sygehus, Kolding, Denmark; Department of Allergy (Dr Schatz), San Diego Medical Center/Kaiser Foundation Hospital, San Diego, CA; Research and Development (Drs Thoren, Ekholm, and Carlsson), AstraZeneca Lund, Sweden; and Department of Medicine (Dr Busse), University of Wisconsin Hospitals and Clinics Authority, Madison, WI.

Correspondence to: Paul M. O’Byrne, MBBCh, FCCP, Firestone Institute of Respiratory Health, St. Joseph’s Healthcare and Department of Medicine, McMaster University, 1200 Mian St W, Hamilton, ON, L8N 3Z5, Canada; e-mail: obyrnep@mcmaster.ca


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(2):511-523. doi:10.1378/chest.12-0412
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The goal of asthma management is to achieve disease control; however, despite the availability of effective and safe medications, for many patients asthma remains uncontrolled. One reason for this is the fear of long-term side effects from the regular use of inhaled corticosteroids (ICSs). Adverse effects of poorly controlled asthma (for example, obesity, pneumonia, and risks to the fetus) can be perceived as side effects of ICSs. Poorly controlled asthma adversely affects children’s cardiovascular fitness, while children with well-controlled asthma perform at the same level as their peers. Children with uncontrolled asthma also have a higher frequency of obesity than children with controlled asthma. Stress can affect asthma control, and children with poorly controlled asthma are more likely to have learning disabilities compared with those with good control. In adults, focused attention and concentration are negatively affected in patients with untreated asthma, and patients with asthma are at greater risk for depression. Also, poorly controlled asthma increases the risks of severe asthma exacerbations following upper respiratory and pneumococcal pulmonary infections. ICSs used to improve asthma control have been demonstrated to improve all of these outcomes. Lastly, the risks of uncontrolled asthma during pregnancy are substantially greater than the risks of recommended asthma medications. Treatments to maintain asthma control are the best approach to optimize maternal and fetal health in the pregnancies of women with asthma. The maintenance of asthma control has significant advantages to patients and greatly outweighs the potential risks of treatment side effects.

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