Clinical decision tool
| Non-adherence | Refractory asthma | Controlled asthma | Comorbidity | |
|---|---|---|---|---|
| Actual adherence >80% | No | Yes | Yes or no | Yes |
| PEFR >80 of area under the curve | Yes or no | No | Yes | Yes |
| AQLQ >5 and ACT >19 | Yes or no | No | Yes | No |
| Exacerbations | Yes or no | Yes or no | No | Yes or no |
The outcome decision tool, at the end of the study the cumulative information on actual adherence. PEFR rate, calculated as the AUC within 80% of normal predicted. ACT and AQLQ considered to be optimal, and exacerbations will be used to describe one of four possible outcomes. Sufficiently non-adherent as the likely reason for failure to progress, asthma that is refractory because despite optimal adherence, both symptoms and lung function and exacerbations occur. Controlled asthma, patients who are no longer impaired nor have exacerbations, and a group of patients who have good adherence and lung function but who continue to have symptoms, therefore suggesting that a significant comorbidity is the likely driver for the ongoing symptoms.
ACT, Asthma Control Test; AQLQ, Asthma Quality of Life Questionnaire; PEFR, peak expiratory flow rate.