Course Jukebox

Course Jukebox

Course Detail

Standard Academic Year
Course delivery methods
Medicine & dentistry
Medical School (FM)
São Paulo, Pinheiros campus
Course Offering Year
Course Offering Month
January - January
Weekday and Period
Course Number

Difficult to Control Asthma: Differential Diagnosis, Associated Co-Morbidities, Treatment Adhrence, Indoor and Outdoor Pollution University of Sao Paulo

Course Overview

Rhinosinusitis, gastro-gastro esophageal reflux disease, vocal fold dyskinesia, anxiety / depression, obesity, sleep apnea, as well as, heart failure or presence of foreign body in the airways, among others, may aggravate or undermine asthma. The high percentage of these co-morbidities in asthmatics has led to an intense debate reflected in the literature on the cause-consequence relationship between both. However, even in relation to rhinitis - allergic disease present in 80% of asthmatics - the pathophysiological connection is inferred, due to the absence of conclusive evidence. The challenge of treating the uncontrolled asthmatic patient with associated morbidities, measuring the impact of the latter, and the need to address them determine the characterization of difficult-to-control asthma. Likewise, symptomatic patients treated as asthmatics and with a low response to treatment, not clinically controlled, may not have asthma. Or they may have adherence to treatment of less than 50%, as well as being exposed to environmental factors, also leading to difficult asthma control. At the request of the World Health Organization, a group of global experts has developed a classification that defines severe asthma in 3 types: 1) untreated or poorly treated asthma related to lack of adequate treatment due to lack of inputs or health infrastructure; 2) difficult to control asthma in patients who are poorly or partially controlled by the presence of comorbidities and / or continuous exposure to triggers and / or low adherence to treatment; and 3) severe asthma dependent on high doses of continuous corticosteroids with High risk of known adverse events or severe asthma refractory to treatment, even at high doses. This discipline aims to clarify the differences between these types of asthma, but focuses on the second type where the aforementioned factors confuse it with the other two types.

Learning Achievement

To present and discuss the current concept of difficult-to-control asthma - called "problematic" - considering the particularities that classify it in some studies as severe asthma. The definition of asthma as morbidity characterized by symptoms such as dyspnea, dry cough and wheezing, commonly leads to the axiom "all that wheeze is asthma." Morbidities from other systems are often present in asthmatics or mimic asthma. Similarly, low adherence to treatment and continuous exposure to triggers lead to uncontrolled asthma. To clarify the relationships between asthma and these morbidities, as well as to identify and treat these factors, it is essential to differentiate an uncontrolled asthma from severe (or both at the same time), including with regard to care and research outcomes. At the end of the course the student will master the concepts necessary for critical analysis of the evidences and plan research projects in the area of __physiopathology, management and treatment of difficult to control asthma


Course prerequisites

Grading Philosophy

Presence, participation in seminars and practical activities

Course schedule

Lecture 1: 1 hour - Definition of severe asthma vs. difficult to control asthma: is it possible to separate them? Lesson 2: 1 hour - How to measure control objectively and evaluate it after treatment of co-morbidities associated with difficult-to-control asthma. Seminars: 5 hours (presentation of articles by students, followed by group discussion) A) Is it asthma or not? Morbidities that mimic asthma B) Is severe asthmatic adherent to treatment? Causes and consequences C) Atopy, rhinitis, sinusitis and asthma control D) Obesity, gastro-esophageal reflux,sleep apnea and asthma control E) Anxiety, depression, vocal cord dyskinesia and asthma F) Asthma and COPD overlap Practical Class: 4 hours Pulmonology oupatient clinic Study Hours: 4 hours

Course type

Online Course Requirement


Alberto Cukier, Rafael Stelmach

Other information

This discipline has didactic continuity with the Discipline "Severe Asthma: Phenotypes and their Implications". It is suggested the student be enrolled in both. Minimum number of students: 6 Maximum number of students: 12

Site for Inquiry

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