Assessing Your Patients
for Severe Uncontrolled Asthma
Driven by Type 2 Inflammation
Is your patient's
asthma
uncontrolled?
Your patient’s asthma is
CONTROLLED
Uncontrolled persistent
 asthma is associated with
 impaired lung function, severe
 exacerbations, recurrent
 symptoms, and poor quality
 of life
Does your patient have
type 2 inflammation?
Your patient may have severe asthma driven by
TYPE 2 INFLAMMATION
~50% to 70% of patients
 with severe asthma have
 type 2
 asthma—characterized by
 type 2 inflammation
Click here for
additional resources
Download
summary PDF
MAKE A SELECTION TO PROCEED
(ESTIMATED TIME TO COMPLETE ≤ 5 MINUTES)
This tool does not provide a diagnosis and is intended for educational purposes.
 
Is your patient's
asthma uncontrolled?
Does your patient have
 type 2 inflammation?
Does your patient
require chronic daily oral
corticosteroids (OCS)?
YES
NO
NOT KNOWN
Maintenance OCS should be avoided if other options are
 available, because of its serious side effects
How often does your patient
require an OCS burst?
Use the slider to enter
the # of exacerbations requiring
an OCS burst in the last year
0
1
2
3
4
≥5
NOT KNOWN
Having ≥2 exacerbations requiring an OCS burst in the
 last year meets criteria for being uncontrolled
Does your patient have
serious exacerbations?
Use the slider to enter the # of
exacerbations requiring hospitalization
or emergency room visit in the last year
0
1
2
3
4
≥5
NOT KNOWN
Having 1 or more serious exacerbations requiring hospitalization
 in the last year meets criteria for being uncontrolled
Does your patient experience
impaired lung function?
Use the slider to indicate
the FEV1 % predicted
0
100
90
80
70
60
50
40
30
20
10
0
NOT KNOWN
Having an FEV1 <80% predicted meets criteria
 for being uncontrolled
Does your patient have any of the following
 relating to poor symptom control?
Is there a presence of any of the following:
Daytime asthma symptoms more than twice/week?
YES
NO
NOT KNOWN
Nighttime awakenings due to asthma?
YES
NO
NOT KNOWN
Short-acting beta-agonist (eg, albuterol) reliever for symptoms more than twice/week?
YES
NO
NOT KNOWN
Any activity limitation due to asthma?
YES
NO
NOT KNOWN
Frequent symptoms or reliever use, activity
 limitations, and/or nighttime awakenings due
 to asthma are criteria for being uncontrolled
Click arrow above to see more
Daytime asthma symptoms more than twice/week?
YES
NO
NOT KNOWN
Frequent symptoms or reliever use, activity
 limitations, and/or nighttime awakenings due
 to asthma are criteria for being uncontrolled
Nighttime awakenings due to asthma?
YES
NO
NOT KNOWN
Frequent symptoms or reliever use, activity
 limitations, and/or nighttime awakenings due
 to asthma are criteria for being uncontrolled
Short-acting beta-agonist (eg, albuterol) reliever for symptoms more than twice/week?
YES
NO
NOT KNOWN
Frequent symptoms or reliever use, activity
 limitations, and/or nighttime awakenings due
 to asthma are criteria for being uncontrolled
Any activity limitation due to asthma?
YES
NO
NOT KNOWN
Frequent symptoms or reliever use, activity
 limitations, and/or nighttime awakenings due
 to asthma are criteria for being uncontrolled
Is the patient's
ACT score known?
Use the slider to indicate
ACT score if known
0
25
20
15
10
5
NOT KNOWN
Having an ACT score <20 qualifies your patient as having
 uncontrolled asthma
Is the patient's
ACQ score known?
Use the slider to indicate
ACQ score if known
0
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
5.5
6
NOT KNOWN
Having an ACQ score ≥1.5 qualifies your patient as having
uncontrolled asthma
Does your patient's asthma control
 depend on taking daily/maintenance
 OCS (eg, prednisone)?
Please make a selection to continue
YES
NO
NOT KNOWN
Patients requiring maintenance OCS may also
 have underlying type 2 inflammation.*
*If asthma is uncontrolled, assess the severe asthma phenotype during
high-dose ICS treatment (or lowest possible dose of OCS). Blood eosinophils and
FeNO should be repeated up to 3x, on the lowest possible OCS dose. Biomarkers
of type 2 inflammation (blood eosinophils, sputum eosinophils, and FeNO) are
often suppressed by OCS. Consult GINA 2020 for full guidance.
What is your patient's blood
eosinophil (EOS) level?
Use the slider to indicate blood EOS level
0
0
100
200
300
400
500
600
700
≥800
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
≥0.8
NOT KNOWN
Patients having blood eosinophils ≥150 cells/µL have type
 2 asthma. Type 2 inflammation is often characterized by
 increased blood eosinophils or increased FeNO, and may be
 accompanied by atopy.*
*If asthma is uncontrolled, assess the severe asthma phenotype during
high-dose ICS treatment (or lowest possible dose of OCS). Blood eosinophils and
FeNO should be repeated up to 3x, on the lowest possible OCS dose. Biomarkers
of type 2 inflammation (blood eosinophils, sputum eosinophils, and FeNO) are
often suppressed by OCS. Consult GINA 2020 for full guidance.
What is your patient’s exhaled
nitric oxide level (FeNO)?
Use the slider to indicate FeNO (ppb)
0
0
10
20
30
40
50
60
70
80
90
100
NOT KNOWN
Patients having FeNO levels ≥20 ppb have type 2 asthma.
 Type 2 inflammation is often characterized by increased
 blood eosinophils or increased FeNO, and may be
 accompanied by atopy.*
*If asthma is uncontrolled, assess the severe asthma phenotype during
high-dose ICS treatment (or lowest possible dose of OCS). Blood eosinophils and
FeNO should be repeated up to 3x, on the lowest possible OCS dose. Biomarkers
of type 2 inflammation (blood eosinophils, sputum eosinophils, and FeNO) are
often suppressed by OCS. Consult GINA 2020 for full guidance.
Do allergies drive
your patient's asthma?
Please select ‘Yes’ or ‘No’ based on
positive specific IgE or skin prick test
YES
NO
NOT KNOWN
Patients with asthma that is clinically allergen-driven as
 defined by specific IgE or positive skin prick test for relevant
 allergens may have type 2 asthma. Type 2 inflammation
 is often characterized by increased blood eosinophils or
 increased FeNO, and may be accompanied by atopy.*
*If asthma is uncontrolled, assess the severe asthma phenotype during
high-dose ICS treatment (or lowest possible dose of OCS). Blood eosinophils and
FeNO should be repeated up to 3x, on the lowest possible OCS dose. Biomarkers
of type 2 inflammation (blood eosinophils, sputum eosinophils, and FeNO) are
often suppressed by OCS. Consult GINA 2020 for full guidance.
Based on your answers, your patient hasDOES NOT have:
UNCONTROLLED
ASTHMA
Having at least one of the following criteria qualifies your patient as having uncontrolled asthma.*
Your answers are marked:
Frequent OCS use
  • Daily OCS
  • Exacerbations: Unknown
Serious exacerbations
  • Exacerbations: Unknown
Impaired lung function
  • FEV1 Unknown% predicted
Poor symptom control
  • Daytime symptoms >2x/wk
  • Nighttime awakenings
  • SABA reliever >2x/wk
  • Activity limitation
  • ACT score: Unknown
  • ACQ score: Unknown
Does your patient have
type 2 inflammation?
Download
summary PDF
This tool does not provide a diagnosis and is intended for educational purposes.
*Adapted from GINA 2020
and ERS/ATS guidelines.
*Adapted from GINA 2020 and ERS/ATS guidelines.
Click below to return to the home page and redo the assessment
Based on your answers, your patient hasDOES NOT have:
Asthma driven by
TYPE 2 INFLAMMATION
Having any of the following criteria identifies type 2 inflammation.*
Your answers are marked:
Need for maintenance OCS
  • Maintenance use
FeNO ≥20 ppb
  • Unknown ppb
Blood EOS ≥150 cells/µl
  • Unknown cells/µl
Clinically allergen-driven asthma†
  • Unknown
Other considerations for type 2 inflammation:
  • Coexisting type 2 diseases such as CRSwNP and atopic dermatitis
  • Sputum eosinophils ≥2% if available
Click here for
additional resources
Download
summary PDF
This tool does not provide a diagnosis and is intended for educational purposes.

*Biomarkers of type 2 inflammation (blood eosinophils, sputum eosinophils,
 and FeNO) are often suppressed by OCS.
Consult GINA 2020 for full guidance.

†Clinically allergen-driven as defined by specific IgE or positive skin prick test for relevant allergens.

Click below to return to the home page and redo the assessment
Additional Resources
Download companion checklist for Severe Uncontrolled Asthma Driven by Type 2 Inflammation
Utilize this guideline-based checklist to determine severe uncontrolled asthma driven by type 2 inflammation.
GINA Pocket Guide for Difficult-to-Treat and Severe Asthma
Review practical patient management strategies from this
 in-depth 'tour' of the Pocket Guide for Difficult-to-Treat and Severe Asthma from the Global Initiative for Asthma, or GINA.
References
✖

Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43(2):343-373.

Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. Updated 2020. https://ginasthma.org/gina-reports/. Accessed January 5, 2021.

Seys SF, Scheers H, Van den Brande P, et al. Cluster analysis of sputum cytokine-high profiles reveals diversity in T(h)2-high asthma patients. Respir Res. 2017;18:39.

Peters MC, Mekonnen ZK, Yuan S, Bhakta NR, Woodruff PG, Fahy JV. Measures of gene expression in sputum cells can identify TH2-high and TH2-low subtypes of asthma. J Allergy Clin Immunol. 2014;133(2):388-394.

PATIENT NAME _________________________________________
DATE _______________
© 2021 Sanofi Genzyme and Regeneron. All rights reserved. MAT-GLB-2002524 V1 03/2021.