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Clinical InvestigationsDifficult-to-Control Asthma: Contributing Factors and Outcome of a Systematic Management Protocol
Section snippets
Patients
Patients who were referred to our pulmonary outpatient clinic because their asthma was difficult to control were selected for participation in this study. A patient with asthma who required more than 10 mg of prednisone every other day for at least three consecutive months per year to remain functional was defined as having difficult-to-control asthma. From January 5, 1982 to October 1, 1990, 42 consecutive and unselected patients prospectively met this definition and served as our study
Outcome of Systematic Protocol
The results of the protocol before and after evaluation and intervention are shown in Figure 1. By closely managing and monitoring the patients and their daily corticosteroid doses over an average of 3.5 years, it was determined that 74 percent of subjects were no longer difficult to control. At the end of the study, this favorable outcome had lasted an average of 1.8 ± 1.5 years. The remaining 26 percent of patients persistently remained difficult to control. The characteristics of these two
DISCUSSION
To our knowledge, this is the first study to assess systematically the usefulness of a specific protocol in treating difficult-to-control asthmatics and to determine the reasons why asthmatics are difficult to control. From the results of our prospective, descriptive study, five findings have emerged that are pertinent to managing the difficult-to-control asthmatic. Future controlled studies will determine whether these findings can be extrapolated to all difficult-to-control asthmatics.
First,
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Presented in part at the Annual Meeting, American Thoracic Society, Anaheim, Calif, May 15, 1991 (Am Rev Respir Dis 1991; 143, Part 2: A632).
Manuscript received July 9; revision accepted October 7.