Background: Despite advances in asthma treatment, severe asthma (SA) still results in high morbidity and use of\nhealth resources. Our hypothesis was that SA patients would achieve adequate control with a systematic protocol,\nincluding oral corticosteroids, budesonide/formoterol maintenance and reliever therapy and a multidisciplinary\napproach to improve adherence.\nMethods: Non-controlled (NC) SA patients were enrolled to receive 2 weeks of oral corticosteroids and 12 weeks of\nformoterol + budesonide. Assessments included asthma control questionnaire (ACQ), asthma control test (ACT),\ndaily symptom diary, lung function and health-related quality of life (HRQoL) questionnaires.\nResults: Of 51 patients, 13 (25.5%) achieved control. NC patients had higher utilization of health resources and\nhigher exacerbation rates. Both controlled (C) and NC patients had significantly reduced ACQ scores after oral\ncorticosteroid treatment. After 12 weeks, C patients continued improving. NC patients did not have significant\nchanges. A similar pattern was found regarding lung function, use of rescue medication, and days free of\nsymptoms. After 2 weeks of oral corticosteroids, an increase occurred in those who achieved the ACQ cut off;\nhowever, 53.8% of C patients had an ACQ < 1.57 versus 21.1% of NC patients (p = 0.03). Both groups had low\nHRQoL at baseline with improvement after intervention.\nConclusions: Despite rigorous, optimized follow-up treatment, 75% of SA patients did not achieve adequate\nsymptom control and presented with impaired quality of life. Conversely, application of a low-cost, easy to\nimplement systematic protocol can prevent up to 25% of SA patients from up-titrating to new and complex\ntherapies, thus reducing costs and morbidity.
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