An Official American Thoracic Society/European Respiratory Society Statement: Asthma Control and Exacerbations

TLDR

Asthma control assessment is pivotal for evaluating treatment response, yet no single outcome measure suffices, so a multicomponent approach is needed to capture both optimal control and future risk reduction. The Task Force was established to standardize outcomes for asthma control, severity, and exacerbations in adults and children ≥6 years, guided by a narrative literature review. The Task Force reviewed diary variables, physiologic measures, composite scores, biomarkers, quality‑of‑life questionnaires, and indirect metrics, then developed new definitions for asthma control, severity, and exacerbations. The Task Force recommends a multicomponent assessment of asthma control for baseline and treatment response in trials and practice, providing a foundation for standardized outcome evaluation.

Abstract

The assessment of asthma control is pivotal to the evaluation of treatment response in individuals and in clinical trials. Previously, asthma control, severity, and exacerbations were defined and assessed in many different ways.The Task Force was established to provide recommendations about standardization of outcomes relating to asthma control, severity, and exacerbations in clinical trials and clinical practice, for adults and children aged 6 years or older.A narrative literature review was conducted to evaluate the measurement properties and strengths/weaknesses of outcome measures relevant to asthma control and exacerbations. The review focused on diary variables, physiologic measurements, composite scores, biomarkers, quality of life questionnaires, and indirect measures.The Task Force developed new definitions for asthma control, severity, and exacerbations, based on current treatment principles and clinical and research relevance. In view of current knowledge about the multiple domains of asthma and asthma control, no single outcome measure can adequately assess asthma control. Its assessment in clinical trials and in clinical practice should include components relevant to both of the goals of asthma treatment, namely achievement of best possible clinical control and reduction of future risk of adverse outcomes. Recommendations are provided for the assessment of asthma control in clinical trials and clinical practice, both at baseline and in the assessment of treatment response.The Task Force recommendations provide a basis for a multicomponent assessment of asthma by clinicians, researchers, and other relevant groups in the design, conduct, and evaluation of clinical trials, and in clinical practice.