Assessment of control in asthma: the new focus in management

Several evidence-based guidelines on the management of asthma have been developed in the last two decades. There is a consensus that a stepped-up approach with anti-inflammatory drugs based on severity forms the cornerstone of treatment. Goals of management have been defined. Studies in several countries have however shown that a large majority of patients have failed to attain the goals of treatment. This has led to a reconsideration of strategy of management. The focus is now shifting to an assessment and a treatment approach based on control. The objective is to achieve and monitor to maintain control. The previous treatment algorithms based on assessment of severity are being discarded. It has been emphasised that the state of control is a dynamic one and therefore a regular assessment and modifications of treatment according to changes in its level are necessary. There is a need to use some method to assess control. A wide range of techniques to assess control are available that can be used depending on the requirements, settings and resources. Assessment of control may be an informal global judgement by the physician or simple tools may be used. Several formal instruments to assess the state of control have also been developed and validated in different settings. These allow a more objective and a quantitative evaluation. Control needs to be assessed at every visit of a patient and treatment adjusted accordingly.