A new Therapeutic approach based on a reinterpretation of asthma control

The concept of asthma control is fundamental because it establishes a target for treatment,
but despite the diversity of definitions, a high proportion of patients fail to achieve it. In
this article, we highlight the shortcomings of the current concept of control by discussing
aspects such as the differences between patient- and physician-perceived control and the
limitations of the tools used to assess it. We also comment on the drawbacks of the stepwise
approach to achieve control recommended by guidelines: the absence of conclusive evidence on the exclusive use of as-needed budesonide/formoterol in mild asthma, the lack
of consideration of the different pharmacological properties of the currently available
inhaled corticosteroids (ICS) and ignoring the existence of different asthma endotypes,
some of which are resistant to these drugs. Other aspects, such as adherence to medication,
the use of rescue medication, the influence of the inhalation device, the particle size, the
pharmacological characteristics, and the lung deposition of ICS, are also mentioned. As
an alternative to the guidelines´ recommendations, we propose a more customized approach
based on the identification of therapeutic goals and treatable traits.