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Asthma control test in real life

We read with interest the article of Caminati and colleagues [1]. We are grateful to them for the opportunity to discuss the asthma control assessment. These authors evaluated the validity of the Asthma Control Test (ACT) in a group of asthmatics. They observed that: i) ACT may not completely reflect airways inflammation and airways obstruction, and ii) ACT seems to be less reliable in patients with important nasal co-morbidity, including severe allergic rhinitis, nasal polyps, and rhinosinusitis, probably because nasal obstruction might affect asthma perception [1]. So, these authors concluded that ACT assessment is much more important in the primary care setting where ACT may be the unique tool for asthma control evaluation [1]. We completely agree with these authors about the relevant impact of upper airways disorders on asthma. On the other hand, we would like to comment on two aspects. The authors proposed a definition of controlled asthma based on: FEV1 80% of predicted, negative response to bronchodilation testing, and FeNO values < 50 ppb. However, we think that this classification could be not compelling for all the asthma phenotypes [2,3]. FeNO is a marker of Th2/Type2-dependent inflammation, negative bronchodilation testing may be associated with intense inflammation, and normal FEV1 values could be compatible with symptomatic asthma [4]. Moreover, rhinoscopy could be insufficient for diagnosing nasal polyps and/or rhinosinusitis [5]. As positive contribution, we would report our experience concerning a group of 619 asthmatics (361 females, mean age 40.22 ± 16.3 years), evaluated in a real-life setting. Our aim was to evaluate the possible impact of some factors (including: lung function, perception of respiratory symptoms assessed by the visual analogue scale (VAS), age, gender, body mass index (BMI), reported bronchial and/or nasal symptoms in the last month, rhinitis co-morbidity, and FeNO measurement) on the ACT outcomes. The patients were managed and