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TAm J Respir Crit Care Med 2004:170:836-844fhttp://ajrccm.atsjournals.org/cgi/reprint/170/8/836ZAm J Respir Crit Care Med 2003:168:1308-1311.jhttp://ajrccm.atsjournals.org/cgi/reprint/168/11/1308TrJournal of Allergy and Clinical Immunology, January 2003.http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6WH4-484KD21-F-1&_cdi=6840&_user=1394906&_orig=browse&_coverDate=01/31/2003&_sk=998889998&view=c&wchp=dGLbVzz-zSkWb&md5=f2ebcaa470d69663cc0638bb152f66cd&ie=/sdarticle.pdff/ 0DTimes New Roman0B 0DTimesNew Roman0B 0F( .  @n?" dd@  @@``_L 8whoosh.wav.WAV 10103RIFFWAVEfmt ++data~~~~~~~~~~~~~~~~~~~~~~~~~~~|||~~~~~zvtvxz|~zvrnlrv||vtrpptz~|xvtv|~~zxvvvz|~xrlhntzzvrrpprrx~|j[QU_|bICCYn[ICY~zlnh]_r|]SUSSjz|x__l~v_]drnUb|nfd_]d]5=rrnj]jz~lMldrx[[_f|YQfWK_xh[zx[CIjzxxdSQz|_fI9WӹM;QnvK;OUx~xj]]YS~ɵlM?plM;CGpٵ[)Kh|% %;xtKQS]ɖbGr|lSnvz~nfS[nëx;Az=+AYݻ|=/1r_ ?|潄W5/Czãf)/pvbMQr|O=OtjdhjlG?G_ɊK3לdQCMppW;1SŷAMz/#?bx͖SAM[hvhYp~~zrvt[]ptWOUtxxd]v~vvxzd_xzh_nrSQltbdp~_lrQ_l][tf]W]~hWfp|fWhnhbU[hzlSCWbYbnxpdhjvjM9Ot]GQ[dpp~hhhdpx~xh]Yntnrp]dlvjQMb|vdjpzxzztljr||_[r~~jb_j|z|xpp~~v]Wh||zx|x|zzndhpxr]Yfntzjl|z||~vppnrzphrxz|~|xtrjjtv~~vz|z||xrrv~xrprtz|||vzxvx|xtx~~~~~~~zxxxx|zxz~~~rrz~|xz~~|vtx|zxz|~~~||zx|||~~zz|zz~~~~|~~||~~||zz|~||z~~~~zxzz|~~~~|~~~|~||~~~~~~~~~~~~~|||~~~~~~~~~~~~~||~~||~||~~~~|||~~~~||||~~~~~~||||~~~~~~~~~~~|~~~~|zz~~~~~~~||||~~||~~~~~|||~~~~~|||~|~|~~~~|z|~~~~~~~|||~~~~~~~~||~~~~~~~~0wz3$h@ P9H91<. ^  252$`:G G  4p!T%* ^ %     ` +.$')8(:  55BK7PM i'-?   7 ^     zv }<R lz&L1 '(0  <hmkj $<)} >      zv    8**7 ,7,2  mkjmkjigr**     'h F;   1O`   ` "    "   O  `   V   V  + # KK Il  8V *%12!  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Luskin, M.D. C- There are multiple barriers to asthma control Access, psychosocial, diagnosis, triggers, adequate prescibing, adherence There is variable response to therapy Pharmacogenetics, race, smoking, obesity Many patients have problematic disease despite adequate diagnosis and prescribing 1/3 of patients with moderate-severe disease are sub-optimally controlled taking standard therapy Adequate Control demands close monitoring, assessing control, addressing risk factors for poor outcomes Obesity, lack of exercise, smoking, non-adherence, poor allergy control Directly addressing the allergic component is helpful for many Anti-IgE therapy, Specific immunotherapy, Environmental control .PJP&P)PRPbPiPHP?P@PP.J&)Rbi  H  ?Pb O ` ` ̙33` 333MMM` ff3333f` f` f` 3` ff3>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> (    6Ѝ "P  T Click to edit Master title style! !$  0h "  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     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U2 ~4Access, psychosocial, diagnosis, triggers, adequate           .-@Times New Roman-. 2 H prescibing    .-@Times New Roman-.  2 , .-@Times New Roman-. 2 ~ adherenceg  .-@Times New Roman-.  2 = .-@Times New Roman-. ?2 [%There is variable response to therapy         .-@Times New Roman-.  2 e .-@Times New Roman-. C2 ~(Pharmacogenetics, race, smoking, obesity         .-@Times New Roman-.  2 = .-@Times New Roman-. [2 [8Many patients have problematic disease despite adequate                  .-@Times New Roman-. -2 ![diagnosis and prescribing       .-@Times New Roman-.  2 <e .-@Times New Roman-. 32 <~1/3 of patients with moderate          .-@Times New Roman-.  2 <-.-@Times New Roman-. (2 <severe disease are sub       .-@Times New Roman-.  2 <M-.-@Times New Roman-. 2 <T optimally   .-@Times New Roman-. :2 R~"controlled taking standard therapy          .-@Times New Roman-.  2 q= .-@Times New Roman-. W2 q[5Adequate Control demands close monitoring, assessing t               .-@Times New Roman-. T2 [3control, addressing risk factors for poor outcomes g               .-@Times New Roman-.  2 e .-@Times New Roman-. B2 ~'Obesity, lack of exercise, smoking, nony           .-@Times New Roman-.  2 -.-@Times New Roman-. 62 adherence, poor allergy control        .-@Times New Roman-.  2 = .-@Times New Roman-. d2 [>Directly addressing the allergic component is helpful for many                .-@Times New Roman-.  2 e .-@Times New Roman-.  2 ~Anti .-@Times New Roman-.  2 -.-@Times New Roman-. ^2 :IgE therapy, Specific immunotherapy, Environmental control              .-@Times New Roman-. I2 /G,When Asthma is Difficult to Control: Summary!          .-@Times New Roman-. '2 Q&Allan T. Luskin, M.D.b   .-@Times New Roman-. 2  Bateman ED   .-@Times New Roman-. 32 eAm J n .-@Times New Roman-. 32 Respir .-@Times New Roman-. 3 2 Crit .-@Times New Roman-. 3'2 Care Med 2004:170:836b .-@Times New Roman-. 3 2 |-.-@Times New Roman-. 3 2 844.-3- e -@Times New Roman-. 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