Severe asthma: Comparison of different classifications of severity and control

• Published in: Respiratory medicine Vol. 156; pp. 1 - 7
• Main Authors: Alves, Alexssandra Maia, Marques de Mello, Luane, Lima Matos, Aline Silva, Cruz, Álvaro Augusto
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2019; Elsevier Limited
• Subjects: Airway management; Asthma; Classification; Classifications; Disease control; Disease management; Experts; Outpatient care facilities; Patients; Standardization; Therapy; Thorax; Brazil; ATS; Therapy; Classifications; ProAR; ERS; Disease management; AQLQ; Asthma; ACQ; PEF; GERD; GINA; SBPT; LABA; ICS; FEV1; GA2LEN/ARIA; NIH-NHLBI; OCS; WHO
• ISSN: 0954-6111; 1532-3064; 1532-3064
• DOI: 10.1016/j.rmed.2019.07.015

Criteria of asthma severity and control lack standardization. to compare classifications of asthma severity and control, applied to patients from a severe asthma clinic. Cross-sectional study of 473 patients followed up for ≥6 months, reclassified using three criteria: 1) the World Health Organization (WHO) 2010, 2) the American Thoracic Society (ATS) 2000, and 3) the European Respiratory Society (ERS)/ATS 2014. In order to evaluate disease control, the 2012 and 2014 Global Initiative for Asthma (GINA) classifications were compared. According to the definition of WHO 2010, 429 had Difficult-to-treat severe asthma and only 12 presented Treatment-resistant severe asthma. 114 patients had Refractory asthma by ATS 2000 and 88 had Severe asthma by ERS/ATS 2014. Considering the definitions of WHO 2010, only 9 out of 12 with Treatment-resistant and 64 out of 429 with Difficult-to-treat severe asthma met the criteria of ATS 2000 and ERS/ATS 2014. As for GINA classification of control, 208 (44%) of the 473 subjects were classified as having asthma controlled by the 2014 criteria, whereas only 45 (10%) patients had controlled asthma by the GINA 2012 criteria. The Kappa statistic indicates the highest agreement of the severity classification occurred between the criteria of ATS 2000 and ERS/ATS 2014 (0.64). Good agreement was found between Refractory asthma ATS 2000 and Severe asthma ERS/ATS 2014 classifications. However, poor agreement was observed between the severity rating proposed by the WHO and other classifications. The GINA control classifications of 2012 and 2014 also agreed poorly. •The definitions of asthma severity and control have changed over the last 20 years.•The agreement between ERS/ATS 2014 and ATS 2000 classifications is good.•The agreement between WHO classification, ATS and ERS/ATS classifications is poor.•The agreement between asthma control by GINA 2012 and GINA 2014 is poor.•Classifications of severity and control are arbitrary and subjective, thus variable.