Severe asthma management in adults

Severe Asthma ◽  
2019 ◽  
pp. 315-326
Author(s):  
Peter G. Gibson ◽  
Kian Fan Chung ◽  
Elliot Israel
Keyword(s):  
Severe Asthma ◽  
Asthma Management

Applying personalized medicine to adult severe asthma

2021 ◽  
Vol 42 (1) ◽  
pp. e8-e16 ◽  
Author(s):  
Angelica Tiotiu
Keyword(s):  
Personalized Medicine ◽  
Severe Asthma ◽  
Negative Impact ◽  
Target Therapy ◽  
Asthma Management ◽  
Future Research ◽  
Biologic Therapies ◽  
Eosinophilic Asthma ◽  
Definition Of ◽  
Structured Approach

Background: Severe asthma is a heterogeneous disease that consists of various phenotypes driven by different pathways. Associated with significant morbidity, an important negative impact on the quality of life of patients, and increased health care costs, severe asthma represents a challenge for the clinician. With the introduction of various antibodies that target type 2 inflammation (T2) pathways, severe asthma therapy is gradually moving to a personalized medicine approach. Objective: The purpose of this review was to emphasize the important role of personalized medicine in adult severe asthma management. Methods: An extensive research was conducted in medical literature data bases by applying terms such as “severe asthma” associated with “structured approach,” “comorbidities,” “biomarkers,” “phenotypes/endotypes,” and “biologic therapies.” Results: The management of severe asthma starts with a structured approach to confirm the diagnosis, assess the adherence to medications and identify confounding factors and comorbidities. The definition of phenotypes or endotypes (phenotypes defined by mechanisms and identified through biomarkers) is an important step toward the use of personalized medicine in asthma. Severe allergic and nonallergic eosinophilic asthma are two defined T2 phenotypes for which there are efficacious targeted biologic therapies currently available. Non-T2 phenotype remains to be characterized, and less efficient target therapy exists. Conclusion: Despite important progress in applying personalized medicine to severe asthma, especially in T2 inflammatory phenotypes, future research is needed to find valid biomarkers predictive for the response to available biologic therapies to develop more effective therapies in non-T2 phenotype.

Inadequate Therapy for Asthma Among Children in the United States

PEDIATRICS ◽  
2000 ◽  
Vol 105 (Supplement_2) ◽  
pp. 272-276
Author(s):  
Jill S. Halterman ◽  
C. Andrew Aligne ◽  
Peggy Auinger ◽  
John T. McBride ◽  
Peter G. Szilagyi
Keyword(s):  
Severe Asthma ◽  
Asthma Management ◽  
The United States ◽  
Asthma Therapy ◽  
National Guidelines ◽  
Cross Sectional ◽  
Asthma Morbidity ◽  
The Past ◽  
Maintenance Medication ◽  
Inadequate Therapy

Objective. Childhood asthma morbidity and mortality are increasing despite improvements in asthma therapy. We hypothesized that a substantial number of children with moderate to severe asthma are not taking the maintenance medications recommended by national guidelines. The objective of this study was to describe medication use among US children with asthma and determine risk factors for inadequate therapy. Methods. The National Health and Nutrition Examination Survey (NHANES) III 1988–1994 provided cross-sectional, parent-reported data for children 2 months to 16 years of age. Analysis focused on children with moderate to severe asthma (defined as having any hospitalization for wheezing, ≥2 acute visits for wheezing, or ≥3 episodes of wheezing over the past year). We defined these children as adequately treated if they had taken a maintenance medication (inhaled corticosteroid, cromolyn, or theophylline) during the past month. Demographic variables were analyzed for independent associations with inadequacy of therapy. The statistical analysis used SUDAAN software to account for the complex sampling design. Results. A total of 1025 children (9.4%) had physician-diagnosed asthma. Of those with moderate to severe asthma (n = 524), only 26% had taken a maintenance medication during the past month. Even among children with 2 or more hospitalizations over the previous year, only 32% had taken maintenance medications. In a logistic regression analysis, factors significantly associated with inadequate therapy included: age ≤5 years, Medicaid insurance, and Spanish language. Children surveyed after 1991, when national guidelines for asthma management became available, were no more likely to have taken maintenance medications than children surveyed before 1991. Conclusion. Most children with moderate to severe asthma in this nationally representative sample, including those with multiple hospitalizations, did not receive adequate asthma therapy. These children may incur avoidable morbidity. Young children, poor children, and children from Spanish-speaking families appear to be at particularly high risk for inadequate therapy.

scholarly journals The study of severe asthma in Latin America and Spain (1994-2004): characteristics of patients hospitalized with acute severe asthma

2009 ◽  
Vol 35 (7) ◽  
pp. 635-644 ◽  
Author(s):  
Gustavo Javier Rodrigo ◽  
Vicente Plaza ◽  
Jesús Bellido-Casado ◽  
Hugo Neffen ◽  
María Teresa Bazús ◽  
...  
Keyword(s):  
Latin America ◽  
Severe Asthma ◽  
Latin American ◽  
Inhaled Corticosteroids ◽  
Pulmonary Function Tests ◽  
Tertiary Care ◽  
Asthma Management ◽  
Case Series ◽  
Acute Severe Asthma ◽  
The Mean

OBJECTIVE: Studies assessing the characteristics and management of patients hospitalized with asthma have been limited to a small number of facilities and have evaluated short time periods. The present study evaluated long-term changes among hospitalized asthma patients at a large number of facilities. METHODS: This was a retrospective, hospital-based observational case series, designated the Study of Severe Asthma in Latin America and Spain, which was conducted in Spain and in eight Latin-American countries. We reviewed the hospital records of 3,038 patients (age range, 15-69 years) hospitalized with acute severe asthma at one of nineteen tertiary-care hospitals in 1994, 1999 and 2004. RESULTS: Over time, the use of inhaled corticosteroids and long-acting β2 agonists increased significantly, whereas the use of theophylline as a controller medication decreased. The utilization of pulmonary function tests also increased. There was a significant reduction in the mean hospital stay (8.5 days, 7.4 days and 7.1 days in 1994, 1999 and 2004, respectively, p = 0.0001) and a significant increase in the mean of the lowest arterial pH at hospital admission. In contrast, there was a significant decrease in the proportion of cases in which PEF was determined in the emergency room (48.6% in 1994 vs. 43.5% in 2004, p = 0.0001). We found the quality of asthma management and care to be generally better in Spain than in Latin America. CONCLUSIONS: Although there have been certain improvements in the management of asthma between severe exacerbations and during hospitalization, asthma management remains suboptimal in Spain and, especially, in Latin America.

scholarly journals Severe Asthma Toolkit: an online resource for multidisciplinary health professionals—needs assessment, development process and user analytics with survey feedback

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e032877
Author(s):  
Steven Maltby ◽  
Peter G Gibson ◽  
Helen K Reddel ◽  
Lorraine Smith ◽  
Peter A B Wark ◽  
...  
Keyword(s):  
Needs Assessment ◽  
Severe Asthma ◽  
Health Professionals ◽  
Healthcare Professionals ◽  
Reference Group ◽  
Asthma Management ◽  
Web Design ◽  
Skills Training ◽  
Evidence Based ◽  
Internet Resource

ObjectivesSevere asthma imposes a significant burden on individuals, families and the healthcare system. New treatment and management approaches are emerging as effective options for severe asthma. Translating new knowledge to multidisciplinary healthcare professionals is a priority. We developed ‘The Severe Asthma Toolkit’(https://toolkit.severeasthma.org.au) to increase awareness of severe asthma, provide evidence-based resources and support decisionmaking by healthcare providers.SettingRoundtable discussions and a survey of Australians clinicians were conducted to determine clinician preferences, format and content for a severe asthma resource.ParticipantsA reference group from stakeholder and consumer bodies and severe asthma experts provided advice and feedback. A multidisciplinary team of international experts was engaged to develop content. Written content was based on up-to-date literature. Peer and editorial review were performed to finalise content and inform web design. Website design focused on user experience, navigation, engagement, interactivity and tailoring of content for a clinical audience.ResultsA web-based resource was developed. Roundtable discussions and a needs assessment survey identified the need for dedicated severe asthma management resources to support skills training. The end-product, which launched 26 March 2018, includes an overview of severe asthma, diagnosis and assessment, management, medications, comorbidities, living with severe asthma, establishing a clinic, paediatrics/adolescents and clinical resources. Analytics indicate access by users worldwide (32 169 users from 169 countries). User survey results (n=394) confirm access by the target audience (72% health professionals), who agreed the toolkit increased their knowledge (73%) and confidence in managing severe asthma (66%), and 75% are likely to use the resource in clinic.ConclusionsThe Severe Asthma Toolkit is a unique, evidence-based internet resource to support healthcare professionals providing optimal care for people with severe asthma. It is a comprehensive, accessible and independent resource developed by leading severe asthma experts to improve clinician knowledge and skills in severe asthma management.

scholarly journals The Danish severe asthma register: an electronic platform for severe asthma management and research

2020 ◽  
Vol 8 (1) ◽  
pp. 1842117
Author(s):  
Susanne Hansen ◽  
Ole Hilberg ◽  
Charlotte Suppli Ulrik ◽  
Uffe Bodtger ◽  
Linda M. Rasmussen ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Asthma Management

Assessment of Severe Asthma Management Practices among Pulmonologists and Allergists

2018 ◽  
Author(s):  
Edward Jackson ◽  
Keith Johnson ◽  
Shari Dermer ◽  
Reynold Panettieri
Keyword(s):  
Severe Asthma ◽  
Management Practices ◽  
Asthma Management

scholarly journals Severe asthma management in the era of biologics: insights of the Italian Registry on Severe Asthma (IRSA)

2021 ◽  
Vol 53 (03) ◽  
pp. 103
Author(s):  
M.B. Bilò ◽  
L. Antonicelli ◽  
M. Carone ◽  
F. De Michele ◽  
F. Menzella ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Asthma Management

scholarly journals Patient and Physician Perspectives on Asthma and Its Therapy in Romania: Results of a Multicenter Survey

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1089
Author(s):  
Dragos Bumbacea ◽  
Carmen Panaitescu ◽  
Roxana Silvia Bumbacea
Keyword(s):  
Maintenance Therapy ◽  
Asthma Control ◽  
Severe Asthma ◽  
Asthma Management ◽  
Asthma Severity ◽  
Treatment Goals ◽  
Cross Sectional ◽  
Multicenter Survey ◽  
Patient Reported ◽  
Asthma Patients

Background and Objectives: Patient’s behaviours, attitudes and beliefs related to asthma and its treatment were shown to influence the adherence to therapy and the level of asthma control. This survey aimed to assess the level of asthma control and patient-reported behaviours, attitudes and expectations related to their disease in Romanian patients. Materials and Methods: This cross-sectional quantitative survey was performed in February-March 2019 and enrolled 70 specialist physicians experienced in asthma management and 433 asthma patients under their care. Results: Of the 433 patients enrolled, 19.4% had mild asthma, 60.5% moderate asthma and 20.1% severe asthma. For the previous 12 months, asthma symptoms, exacerbations and emergency room visits were common in the sample analysed, with significantly higher figures in severe asthma patients (p < 0.001). The most important treatment goal for asthma patients was participation in all activities of daily living, while for physicians this was preventing asthma exacerbations. The valuation of the treatment goals was different between patients with severe asthma and those with mild and moderate forms. Based on the patients’ responses, 3 attitude clusters were identified: empowered savvy (36.5% of the patients), pessimistic non-compliers (43.2%), and anxious strugglers (20.3%). “Empowered savvy” had the lowest frequency of severe asthma, the highest adherence to maintenance therapy and the highest level of confidence in the effectiveness of asthma medication. The opposite of this attitude cluster is the “anxious strugglers”, containing more patients with severe asthma, a higher score for worries about asthma therapy and better self-reported knowledge of their treatment, contrasting with a proportion of 25% taking maintenance therapy only when having breathing difficulties. Conclusion: Asthma control in Romania remains poor, with frequent exacerbations and hospitalizations. The differences in treatment goals found between patients and physicians and between different asthma severity groups suggest the need for more patient-centred approaches.

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