Uniform definition of asthma severity, control, and exacerbations: Document presented for the World Health Organization Consultation on Severe Asthma

Jean Bousquet, Eva Mantzouranis, Alvaro A. Cruz, Nadia Aït-Khaled, Carlos E. Baena-Cagnani, Eugene R. Bleecker, Chris E. Brightling, Peter Burney, Andrew Bush, William W. Busse, Thomas B. Casale, Moira Chan-Yeung, Rongchang Chen, Badrul Chowdhury, Kian Fan Chung, Ronald Dahl, Jeffrey M. Drazen, Leonardo M. Fabbri, Stephen T. Holgate, Francine KauffmannTari Haahtela, Nikolaï Khaltaev, James P. Kiley, Mohammad R. Masjedi, Yousser Mohammad, Paul O'Byrne, Martyn R. Partridge, Klaus F. Rabe, Alkis Togias, Christiaan Van Weel, Sally Wenzel, Nanshan Zhong, Torsten Zuberbier

Research output: Contribution to journalArticlepeer-review

508 Scopus citations


Asthma is a global health problem affecting around 300 million individuals of all ages, ethnic groups and countries. It is estimated that around 250,000 people die prematurely each year as a result of asthma. Concepts of asthma severity and control are important in evaluating patients and their response to treatment, as well as for public health, registries, and research (clinical trials, epidemiologic, genetic, and mechanistic studies), but the terminology applied is not standardized, and terms are often used interchangeably. A common international approach is favored to define severe asthma, uncontrolled asthma, and when the 2 coincide, although adaptation may be required in accordance with local conditions. A World Health Organization meeting was convened April 5-6, 2009, to propose a uniform definition of severe asthma. An article was written by a group of experts and reviewed by the Global Alliance against Chronic Respiratory Diseases review group. Severe asthma is defined by the level of current clinical control and risks as "Uncontrolled asthma which can result in risk of frequent severe exacerbations (or death) and/or adverse reactions to medications and/or chronic morbidity (including impaired lung function or reduced lung growth in children)." Severe asthma includes 3 groups, each carrying different public health messages and challenges: (1) untreated severe asthma, (2) difficult-to-treat severe asthma, and (3) treatment-resistant severe asthma. The last group includes asthma for which control is not achieved despite the highest level of recommended treatment and asthma for which control can be maintained only with the highest level of recommended treatment.

Original languageEnglish (US)
Pages (from-to)926-938
Number of pages13
JournalJournal of Allergy and Clinical Immunology
Issue number5
StatePublished - Nov 2010
Externally publishedYes


  • Asthma
  • Control
  • Definition
  • GARD
  • Risk
  • Severity

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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