Abstract
Asthma is current dominating clinical problem of developed countries, where incidence and prevalence is still growing. Despite the significant developments in pharmacotherapy there still persists loss of effective asthma control in 5% of the patients with asthma, who consumes disproportionally high cost of medical care.
The reasons of poor response to current therapy is mostly non-compliance or presence of untreated and unrecognized comorbidities and complicating factors as gastroesophageal refluxive disesase, rhinosinusitis and psychosocial comorbidities. These situation is described as difficult-to-treat asthma.
So called severe refractory asthma si present when patient is compliant to properly indicated therapy, the comorbidities and complicating factors are treated and controlled and asthma is still uncontrolled. These patients should be candidates for phenotype - specific therapies with monoclonal antibodies or bronchial thermoplasty.
All patients suffering from uncontrolled asthma for longer than 6 months despite extensive diagnostic and therapeutic effort according to current asthma guidelines should be reffered to specialized severe asthma centers of the Czech National Severe Asthma Centers.