![]() Nocturnal symptoms are accompanied by circadian variations in small airway inflammation, hyperresponsiveness, and dysfunction in asthma. 7, 8 Similarly, the visual analog scale (VAS) has been evaluated as a useful tool for assessing the perception of respiratory symptoms. 7, 8 In critical practice, the ACT has 5 items and the total ACT score, but not each item, is expressed as the disease control level. An asthma control test (ACT) has been evaluated for understanding asthma control levels and is used worldwide. ![]() 6 Understanding the perception of asthma symptoms is necessary for the assessment of asthma control levels. The goal of asthma management is to achieve a well-controlled asthma level. 4 A global study found that undertreatments are still observed for the management of asthma worldwide. Daytime and nighttime asthma symptoms were experienced by 51.5% and 44.9% of patients, respectively. 3 Japanese internet surveys reported that considering the GINA criteria, 49.8% and 15.1% of patients had partly controlled and uncontrolled asthma, respectively. 2 A 2016 global cross-sectional study demonstrated that among 8111 patients, 18.0% and 38.5% of patients had partly controlled and uncontrolled asthma, respectively. 1 In 2009, a US survey demonstrated that although 71% of patients self-reported “completely controlled” or “well-controlled” statuses, the percentages of patients with asthma who needed urgent care visits twice and emergency department visits once per year were 67% and 60%, respectively. 4 In 2021, a survey conducted in Middle East and North Africa, which used the Global Initiative for Asthma (GINA) criteria, reported that the percentage of patients with partly controlled and uncontrolled asthma was 29.1% and 41.5%, respectively. ![]() Uncontrolled and/or severe asthma is a social problem worldwide, 1–3 as well as in Japan.
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