Table 2. Checklist to distinguish ‘severe asthma’ from ‘difficult-to-treat asthma’.

Checklist
Is the patient a current smoker? Have you encouraged him/her to quit smoking?
Do you check how well the patient uses the inhaler and educate them on how to use it properly (at each visit)?
Do you understand the factors that keep patients not adherent to their medications?
Are there any adverse events due to asthma medications? (e.g., oral candidiasis, cough, hoarseness, dry mouth, or palpitation)
Has the patient informed of avoidance of the sensitized allergens or non-specific stimuli?
	Environment control (HDM, pollens, molds, fine dust, air pollution, cold air, or other seasonal factors)
	Occupational stimuli/work-related symptoms
	Pets (dogs, cats, birds)
	Drug adverse effects (e.g., cough, chest tightness, or dyspnea due to aspirin, ACEi, or β-blockers)
	Does the patient need to be encouraged to exercise or lose weight?
Have you ever considered assessing and managing the comorbidities of the patient?
	Chronic rhinosinusitis (with or without nasal polyps) by imaging studies (X-ray or CT scan of the PNS)
	GERD by endoscopy or preemptive treatment with proton pump inhibitors
	Obstructive sleep apnea by polysomnography
	Obesity
	Psychological distress (anxiety and depression)
	Structural lung diseases (COPD or bronchiectasis) by imaging studies (chest CT scan)

HDM, house dust mites; ACEi, angiotensin-converting enzyme inhibitors; PNS, paranasal sinuses; GERD, gastroesophageal reflux disease; COPD, chronic obstructive pulmonary diseases; CT, computed tomography.