| The definition of severe asthma requires that one or both of the following levels of treatment for the previous year has been needed to prevent asthma from becoming uncontrolled or asthma that remains uncontrolled despite this level of treatment: |
- Treatment with guidelines suggested medications for GINA steps 4-5 asthma (high dose inhaled glucocorticoid* and long-acting beta agonist [LABA] or leukotriene modifier/theophylline) for the previous year
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- Treatment with systemic glucocorticoid for ≥50% of the year
|
| Uncontrolled asthma is defined as at least one of the following: |
- Poor symptom control: ACQ consistently ≥1.5, ACT <20 (or "not well controlled" by NAEPP/GINA guidelines)
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- Frequent severe exacerbations: two or more bursts of systemic glucocorticoids (three or more days each) in the previous year
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- History of serious exacerbation: at least one hospitalization, intensive care unit stay, or mechanical ventilation in the previous year
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- Airflow limitation: after appropriate bronchodilator withhold FEV1 <80% predicted (in the face of reduced FEV1/FVC defined as less than the lower limit of normal)
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| The ERS/ATS definition of high doses of various inhaled glucocorticoids in relation to patient age (in mcg/day): |
| | Age 6 to 12 years | Age >12 years |
| Beclomethasone | ≥320 (HFA MDI) | ≥1000 (HFA MDI) |
| Budesonide | ≥800* (MDI or DPI) | ≥1600¶ (MDI or DPI) |
| Ciclesonide | ≥160 (HFA MDI) | ≥320 (HFA MDI) |
| Fluticasone propionate | ≥500Δ (HFA MDI or DPI) | ≥1000◊ (HFA MDI or DPI) |
| Mometasone | ≥500§ (DPI) | ≥800¥ (DPI) |
