If you appear to have triggered asthma through exercise (exercise-induced asthma), you might be asked to do physical activity to see if it causes symptoms. Regular assessment and monitoring is designed to determine whether asthma treatment goals are met and if asthma is controlled. If asthma is not controlled, it is a significant exposure to asthma (Fuhlbrigge et al. 2002), reduced quality of life (Schatz et al. 2005b) and increased health use (Schatz et al. 2005a; Vollmer et al. 2002). The level of control of asthma (well controlled, not well controlled or poorly controlled) is the degree to which the two dimensions of asthma manifestations – alteration and risk – are minimized by therapeutic intervention. The level of control at the time of the follow-up assessment will determine the clinical measures, i.e. whether treatment should be maintained or adapted. In previous guidelines (EPR- 2 1997; GINA 2002), control parameters were selected based on research findings that used individual results to assess the effectiveness of asthma treatments.
The composite list of objectives reflected the panel`s views on a comprehensive list of relevant outcomes that could define asthma control. A large-scale recent international study showed that significant reductions in the rate of severe exacerbations and improved quality of life were achieved by seeking asthma control and adapting treatment to achieve this. By the end of one year, 30% of patients had total control (i.e. no signs or symptoms of asthma) and 60% had achieved well-controlled asthma (Bateman et al. 2004). Other comorbidities have been discussed elsewhere 4 and are an integral part of the evaluation. In particular, obesity can cause a non-flammable phenotype, and weight loss should be encouraged. There must be strong suspicions of gastroesophageal reflux disease, especially in young children.
Although it is possible to measure inflammatory markers in sputum, exhaled air, serum and urine, they have not yet been used in the clinical management of severe asthma. The rationale for their use is that many children are being prescribed increasing doses of anti-inflammatory therapies, which does not make sense if there is no residual inflammation. In addition, it is likely that in the future, inflammatory regimens will be able to determine the treatment to be offered. When assessing the impact on prescribing ICS; It is found that FeNO has led to an increase in drugs to start ICS in 100% of patients who are not currently taking ICS (Table 4). This is consistent with the BTS guidelines, which recommend that all patients be diagnosed with asthma and that those with an average chance of asthma start directly at a low dose of ICS . It also recommends that, due to very limited side effects due to the long-term use of low-dose ICS, patients should be kept on these. This runs counter to NICE, which recommends that SABA be offered to adults and children newly diagnosed with asthma and that it be prosecuted only in all patients with rare and ephemeral wheeze and normal lung function .