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Difficult, therapy-resistant asthma: definition and clinical features.

Difficult therapy-resistant asthma may be defined as poorly controlled asthma in terms of chronic symptoms, episodic exacerbations, persistent and variable airways obstruction despite a continued requirement for short-acting beta 2-agonists despite the use of high doses of inhaled steroids. It is necessary to confirm the diagnosis of asthma, to exclude alternative diagnosis, and to make sure that adequate asthma treatment is given and being adhered to. Difficult therapy-resistant asthma is likely to consist of several clinical subgroups characterized by the temporal sequence of exacerbations and symptoms, the chronicity and rapidity of symptoms and response to treatment, such as brittle asthma, chronic difficult asthma, and fatal asthma. Exacerbating factors such as gastrooesophageal reflux, sinorhinitis, allergen exposure, drugs, respiratory tract infections and psychosocial factors must be addressed.