Table 1.

Refractory asthma: workshop consensus for typical clinical features^*

Major characteristics
In order to achieve control to a level of mild to moderate persistent asthma: Treatment with continuous or near-continuous (50% of year) oral corticosteroids Requirement for treatment with high-dose inhaled corticosteroids
Drug	Dose (μg/d)	Dose (puffs/d)
a. Beclomethasone dipropionate	>1260	>40 puffs (42 μg/inhalation) >20 puffs (84 μg/inhalation)
b. Budesonide	>1200	>6 puffs
c. Flunisolide	>2000	>8 puffs
d. Fluticasone propionate	>880	>8 puffs (110 μg), >4 puffs (220 μg)
e. Triamcinolone acetonide	>2000	>20 puffs
Minor characteristics Requirement for daily treatment with a controller medication in addition to inhaled corticosteroids, eg, long-acting β-agonist, theophylline, or leukotriene antagonist Asthma symptoms requiring short-acting β-agonist use on a daily or near-daily basis Persistent airway obstruction (FEV1 <80% predicted; diurnal PEF variability >20%) One or more urgent care visits for asthma per year Three or more oral steroid ‘bursts’ per year Prompt deterioration with 25% reduction in oral or inhaled corticosteroid dose Near-fatal asthma event in the past

Note:

^*Requires that other conditions have been excluded, exacerbating factors treated, and patient felt to be generally adherent.

Definition of refractory asthma requires one or both major criteria and two minor criteria. Copyright © 2010, American Thoracic Society. Reproduced with permission from Proceedings of the ATS workshop on refractory asthma: current understanding, recommendations, and unanswered questions. American Thoracic Society. Am J Respir Crit Care Med. 2000;162(6):2341–2351.