A combined approach to assessment of asthma control from both “current clinical control” (symptoms,
night waking, reliever use and activity limitation) and “future risk” (risk of exacerbations, development of
fixed airflow limitation or medication side-effects) was adopted in GINA 2010, following the
recommendations of an American Thoracic Society (ATS)/European Respiratory Society (ERS) task force
. The significance of this change was not necessarily obvious, since in typical allergic asthma and with a
conventional ICS-based treatment model, short-term improvement in symptoms is often paralleled by
longer-term reduction in exacerbations. However, in different asthma phenotypes or with different
treatments, discordance may be seen between symptoms and risks. For example, symptoms can be reduced
by placebo [22] or with long-acting β2-agonist (LABA) monotherapy , without any reduction in the
risk of exacerbations from untreated airway inflammation; and newer regimens or treatments such as ICS/
formoterol maintenance and reliever therapy and anti-interleukin (IL)-5 reduce exacerbation risk
with little difference from comparators in levels of symptom control. Discordance in treatment response
between symptoms and risk can be biologically informative about the underlying mechanism