Achieving Guideline-Defined

Over-All Asthma Control

Prof. Dr. Tamsil Syafiuddin, Sp.P (K)

Definition of Asthma

A chronic inflammatory disorder of the airways

Many cells and cellular elements play a role

Chronic inflammation is associated with airway

hyperresponsiveness that leads to recurrent
episodes of wheezing, breathlessness, chest
tightness, and coughing

Widespread, variable, and often reversible

airflow limitation

Asthma Inflammation: Cells and

Mediators

Source: Peter J. Barnes, MD

Mechanisms: Asthma
Inflammation

Source: Peter J. Barnes,

MD

Burden of Asthma

Asthma is one of the most common chronic

diseases worldwide with an estimated 300
million affected individuals

Prevalence increasing in many countries,

especially in children

A major cause of school/work absence

Asthma Prevalence and Mortality

Source: Masoli M et al. Allergy 2004

Figure 1 Prevalence of current wheeze according to the written questionnaire in the 13-14 year
age group. See text for definition of current wheeze. The symbols indicate prevalence values of
<5% (blue square), 5 to <10% (green circle), 10 to <20% (yellow diamond) and >20% (red star).

Indonesia: 2-3%
(1990)*

Lai, C K W et al. Thorax 2009;64:476-483

* JAMA 2001;286:

Factors that Influence Asthma

Development and Expression
Host Factors
Genetic
- Atopy
- Airway
hyperresponsiveness
Gender
Obesity

Environmental Factors
Indoor allergens
Outdoor allergens
Occupational sensitizers
Tobacco smoke
Air Pollution
Respiratory Infections
Diet

Asthma Control
What is asthma control as defined in
the guidelines?
How can we achieve this?
Is it possible to do this in a simple
way?

Elements of control

Levels of Asthma Control

(GINA 2008)
Characteristic
Daytime symptoms

Controlled

Partly controlled

(All of the following)

(Any present in any week)

None (2 or less /
week)

More than
twice / week

Limitations of
activities

None

Any

Nocturnal
symptoms /
awakening

None

Any

Need for rescue /

None (2 or less /
reliever treatment week)
Lung function
(PEF or FEV1)
Exacerbation

Normal
None

More than
twice / week

Uncontrolled

3 or more
features of
partly
controlled
asthma
present in
any week

< 80% predicted or

personal best (if
known) on any day
One or more / year

1 in any week

Overall Asthma Control

achieving

Current Control

achieving

Future Risk
defined by

defined by

Symptoms

Reliever Use

Activity

Lung Function

Instability /
worsening

Exacerbations

Lung
function
loss

Medication
adverse effect

SMART
A better option for

Asthma
Control?

SMART

Achieve Overall Asthma Control

SMART treatment is the management of persistent

asthma with only one inhaler Budesonide/Formoterol
Turbuhaler

Patients take an adequate maintenance dose of

Budesonide/Formoterol with additional inhalations as
needed to improve control and provide immediate relief
from symptoms

Patients do not need to have a separate as-needed

inhaler

Overall Asthma Control is possible

with SMART Whats the Evidence?
Over 16,000 patients
Multicenter
Multinational
Pediatrics
Adolescents
Adults
Elderly

GINA 2008