الفهرس 
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Abstract
D
ifficult-to-treat asthma (DTA) has several synonyms; each points to a feature of the disease. chronic severe asthma, steroid-dependent asthma, difficult-to-control asthma, and refractory asthma are different terminologies of the same condition (Currie et al., 2009).
The study aimed at assessing prevalence and risk factors of difficult-to-control asthma among asthmatic patients attending Kafr Elsheikh chest hospital. All patients that started the study underwent history taking, physical examination and spirometric evaluation. Then, management plan was revised with ensuring adherence to therapy. After two weeks of follow up, the patients were reevaluated again. Then ACQ was used to categorize patients into controlled and difficult-to-control asthmatic patients.
This study revealed that difficult-to-control asthma prevailed in 27.5% of patients. Fifty five percent of patients aged ≥ 54 years, male to female ratio was 1:1. About 83% were overweight and obese. Fifty five percent came from rural areas. Concerning social class; 35%, 40% and 25% had low, middle and high SES respectively. There is statistically significant improvement in spirometric measures including FEV1, FVC and FEV1/FVC two weeks after starting and strict follow up of therapy. There is statistically non-significant relation between presence of difficult-of-control asthma and either age, gender, residence, SES, BMI, presence of chronic disease, using influenza vaccine of patients.
There is statistically significant relation between presence of difficult-to-control asthma and family history of asthma, presence of GERD, asthma duration, presence of other allergies and allergic rhinitis of patients.
On doing multivariate analysis, it is found that GERD, positive family history, presence of allergic rhinitis, associated allergies and disease duration ≥ 10 years were independent risk factors for difficult-to-control asthma as they increased risk by 4.54, 12.94, 1.389, 13.74 and 14.733 folds respectively.
By the end of this study, we concluded that after eliminating non-adherence factor, GERD, positive family history, presence of allergic rhinitis, associated allergies and disease duration ≥ 10 years were independent risk factors for difficult-to-control asthma. Hence, patients who had these factors should receive special attention to ensure proper asthma control.