Risk Factors Associated to Difficult-to-control Asthma

Study design: interventional

Patients selection:

Seventy-four severe asthma patients, aged between 18 and 65 years old were recruited from the outpatient clinics of the Pulmonary Division of the University of São Paolo Hospital.

Severe asthma were defined according to GINA. Intervention: after 2 weeks screening period patients were treated with high inhaled corticosteroid dose plus long acting beta 2 agonist during 12 weeks plus oral corticosteroid ( prednisone 40 mg/day) during 2 weeks.

Procedures ( baseline, after 2 weeks and 12 weeks): asthma control questionnaire (ACQ), asthma control (ACT) test, lung function test, quality of life questionnaire (SGRQ and SF-36), exhaled nitric oxide (FeNO), induced sputum (IS). After 12 weeks patients underwent the following evaluation: Upper Digestive Endoscopy, Esophageal 24hs pHmetry, High Resolution Chest Tomography, Nasoscope exam,Bronchofibroscopy with endobronchial biopsy.

Inclusion criteria

• Age between 18 and 65 years
• Diagnosis of moderate to severe asthma (GINA) for at least one year
• Presence of airway obstruction reversibility (documented within the last 5 years before the start-up of study)
• Smoking, non-smoking or ex-smoking patients of <30 pack-years.
• Need of inhaled corticosteroid (IC),> or equal 1000mcg of Beclomethasone Dipropionate (DPB) or similar in the last year plus beta 2 long duration agonist in the last year.
• At least one exacerbation with the need of oral corticosteroid in the last year.

Exclusion criteria

• Pregnant women;
• Co-morbidities that may interfere with the management of the study;
• Patients who cannot understand the procedures of the study or who are not able to provide their free and clarified consent;
• Patients with other pulmonary diseases which may interfere with the evaluation of the study.