Before concluding that a patient has severe, uncontrolled
asthma, it is important to confirm the diagnosis of asthma
and identify and address any potentially exacerbating factors. If the diagnosis of asthma is confirmed and addressing
contributing factors does not lead to control of symptoms and impairment, then biomarkers such as eosinophil levels
and FENO may help inform treatment choice. Reinforcing appropriate inhaler technique and the importance of adherence are key elements in therapy. Decisions about changes in treatment require communication and collaboration
with the patient who must adhere to the therapy and use the inhalers or other devices. Emerging information about
asthma phenotypes and investigational therapies targeted to specific mediators [See Sidebar, Investigational therapies for eosinophilic asthma] may facilitate increased personalization of treatment choice in the future.