Considerations in difficult-to-control asthma.

Background: Difficult-to-control asthma includes those patients who require treatment with high-dose inhaled glucocorticosteroid (ICS) plus a second controller and/or systemic glucocorticosteroids to manage. The exact percentage of "difficult to treat," "refractory," "severe," or "brittle" asthma is 3% to 10% of all asthmatic patients, but this group of asthmatics use the majority of resources for the entire asthmatic population.

Methods: Medline searches for the terms "difficult to control," "severe," "refractory," "brittle," and asthma were done and the results were reviewed.

Results: Patterns for difficult-to-control asthma emerge from concepts of compliance, comorbidity, and endotypes, which give the practitioner pathways for analyzing this subset of asthma patients.

Conclusion: The ear, nose, and throat (ENT) physician can be of significant help to other asthma specialists in the recognition of the difficult-to-control asthmatic, as well as providing specific specialized diagnostic skills and the reinforcement of adherence to medical regimens.