Browse the corpus

©2013 UpToDate ® Print Email ATS workshop consensus for definition of severe/refractory asthma* The definition of refractory asthma requires one or both major criteria and two minor criteria Major criteria To achieve control to level of mild-moderate persistent asthma: 1. Treatment with continuous or near continuous (≥50 percent of year) oral glucocorticoids 2. Treatment with high-dose inhaled glucocorticoids: Beclomethasone >1260 mcg/day Budesonide >1200 mcg/day Fluticasone >880 mcg/day Minor criteria 1. Requirement for additional daily treatment with a controller medication, eg, long-acting β-agonist, theophylline, or leukotriene antagonist 2. Asthma symptoms requiring short-acting β-agonist use on a daily or near daily basis 3. Persistent airflow limitation (FEV1 <80 percent predicted; diurnal peak expiratory flow variability >20 percent) 4. One or more urgent care visits for asthma per year 5. Three or more oral glucocorticoid bursts per year 6. Prompt deterioration with ≤25 percent reduction in oral or inhaled glucocorticoid dose 7. Near-fatal asthma event in the past * Requires that other conditions have been excluded, exacerbating factors treated, and patient believed to be generally adherent. Adapted with permission from: Wenzel SE, Fahy JV, Irvin CG, et al. Proceedings of the ATS Workshop on Refractory Asthma: current understanding, recommendations and unanswered questions. Am J Respir Crit Care Med 2000; 162:2341-51.