Table 1.

American Thoracic Society Criteria for Severe/Refractory Asthma^*

Major criteria

Treatment with continuous or near continuous (>50% of the year) oral corticosteroids

Need for treatment with high-dose inhaled corticosteroids

Minor criteria

Need for additional daily treatment with a controller medication (long-acting β-agonist, leukotriene receptor antagonist, theophylline)

Asthma symptoms needing short-acting β-agonist use on a daily or near daily basis

Persistent airway obstruction (FEV1 < 80% predicted, diurnal peak expiratory flow variability >20% predicted)

One of more urgent care visits for asthma per year

Three or more oral steroid bursts per year

Prompt deterioration with <25% reduction in oral or intravenous corticosteroid use

Near fatal asthma event in the past

^*One major criterion plus two minor criteria required for diagnosis; other diseases have been excluded, exacerbating factors treated, and patient is generally adherent.