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“Difficult Asthma”Difficult Asthma: Not as Easy as You Think: Not as Easy as You Think

Matthew Masoli, MD
Author and Funding Information

From the Plymouth Hospitals NHS Trust.

CORRESPONDENCE TO: Matthew Masoli, MD, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, PL68DH, England; e-mail: matthew.masoli@nhs.net


CONFLICT OF INTEREST: None declared.

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


Chest. 2015;148(4):843-844. doi:10.1378/chest.15-0954
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The global prevalence of asthma is estimated to be 300 million and is expected to grow by > 100 million by 2025.1 Patients with severe and difficult-to-treat asthma comprise a small proportion (5%-10%) of all patients with asthma, yet they are responsible for a disproportionate degree of asthma morbidity and costs.2

The definition of difficult-to-treat/severe asthma has been debated many times. The most recent is from the 2014 American Thoracic Society/European Respiratory Society Task force report, in which the term “severe asthma” is reserved for patients in whom alternative diagnoses have been excluded, comorbidities treated, trigger factors removed, and adherence confirmed and who still have poor asthma control or frequent exacerbations despite high-intensity treatment.3 The distinction between difficult asthma and severe refractory asthma is obviously important; however, in practice, it remains a significant challenge to accurately identify, characterize, and treat these patients. To quote the Chinese philosopher Lao Tzu, perhaps we should “anticipate the difficult by managing the easy.”

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