Optimal Asthma control goes beyond exacerbation reduction
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Understanding the definitions of di cult-to-treat and severe asthma starts with the concept of uncontrolled asthma. Uncontrolled asthma includes one or both of the following:
- Poor symptom control (frequent symptoms or reliever use, activity limited by asthma, night waking due to asthma)
- Serious exacerbations (1/year) requiring hospitalization and risk for poor quality of life1.
Asthma exacerbations may contribute to the accelerated decline in lung function2.
- Higher Exacerbation Rates
- Exacerbations were 3 times more likely to occur in patients with very poorly controlled asthma than in those with improved asthma control3.
- Reduced Lung Function4
- Airway remodeling is often driven by persistent type 2 inflammation4. It leads to loss of lung function5
- Asthma exacerbations may contribute to the accelerated decline in lung function that occurs over time in both children and adults with asthma2.
- Reduced QoL6
- Uncontrolled asthma was associated with outdoor, physical, and other daily activities limitations6.
- Anxiety and depression are frequent in asthmatic patients, and there is a significant correlation between these disorders and a poor asthma control7.
OCS: Oral corticosteroids, QoL: Quality of life
Asthma management still represents a challenge worldwide. Particularly, severe asthma and asthma control are the main unmet needs in the field8. Patients with severe asthma† require tailored evidence-based interventions to meet their needs9.
Thus, there is a need to improve the assessment of control from both a patient and physician perspective through education measures10.
†Severe Asthma: Defined as asthma which requires maximum controller therapy to prevent a patient from becoming uncontrolled or which, despite high dose therapy remains uncontrolled.
References
- Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention, 2020 update. https://ginasthma.org/ginareports/Last accessed: 21/8/2020
- O Byrene B, Pedersen S, Lamm C et al. severe exacerbation and decline in lung function in asthma. Am J Respir Crit Care Med. 2009;179:1924.
- Haselkorn T, Fish JE, Zeiger RS, et al; TENOR Study Group. Consistently very poorly controlled asthma, as defined by the impairment domain of the Expert Panel Report 3 guidelines, increases risk for future severe asthma exacerbations in The Epidemiology and Natural History of Asthma: Outcomes and Treatment.
- Israel E, Reddel H. Severe and Di culttoTreat Asthma in Adults. New Engl Journal of Medicine. 2017;377:965976;
- National Heart, Lung, and Blood Institute(NHLB). National Asthma Education and Prevention Program Expert Panel Report 3:Guidelines for the Diagnosis and Management of Asthma Full Report 2007.
- Haselkorn T, Chen H, Miller DP, Fish JE, Peters SP, Weiss ST, Jones CA. Asthma control and activity limitations:-insights from the Real-world Evaluation of Asthma Control and Treatment (REACT) study. Annals of allergy, asthma &.immunology. 2010 Jun 1;104(6):471-7
- Di Marco F, Verga M, Santus P, et al. Close correlation between anxiety, depression, and asthma control. Respir Med.2010;104(1):22-28.
- Caminati M, Senna G. Uncontrolled severe asthma: starting from the unmet needs. Current medical research and opinion. 2019 Feb 1;35(2):175-7.
- Majellano EC, Clark VL, Winter NA, Gibson PG, McDonald VM. Approaches to the assessment of severe asthma: barriers and strategies. Journal of asthma and allergy. 2019;12:235.
- Gru ydd-Jones K. Unmet needs in asthma. Therapeutics and clinical risk management. 2019;15:409.
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