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      Is Open Access

      Control of asthma in real life: still a valuable goal?

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          Abstract

          Although studies show that control of asthma can be achieved in the majority of patients, surveys repeatedly show that this is not the case in real life. Important measures to implement in order to achieve asthma control are trained healthcare professionals, a good patient–doctor relationship, patient education, avoidance of exposure to triggers, personalised management and adherence to treatment. These measures help the majority of asthma patients but have not yet been widely implemented and there should be a concerted action for their implementation. Moreover, further and focused research is needed in severe/refractory asthma.

          Abstract

          Achieving asthma control requires implementation of evidence-based guidelines and further research into severe asthma http://ow.ly/KzrOp

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          International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma.

          Kian Fan Chung, Sally Wenzel, Jan Brozek … (2014)
          Severe or therapy-resistant asthma is increasingly recognised as a major unmet need. A Task Force, supported by the European Respiratory Society and American Thoracic Society, reviewed the definition and provided recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults. A literature review was performed, followed by discussion by an expert committee according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach for development of specific clinical recommendations. When the diagnosis of asthma is confirmed and comorbidities addressed, severe asthma is defined as asthma that requires treatment with high dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming "uncontrolled" or that remains "uncontrolled" despite this therapy. Severe asthma is a heterogeneous condition consisting of phenotypes such as eosinophilic asthma. Specific recommendations on the use of sputum eosinophil count and exhaled nitric oxide to guide therapy, as well as treatment with anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty are provided. Coordinated research efforts for improved phenotyping will provide safe and effective biomarker-driven approaches to severe asthma therapy.
          Article 0 comments Cited 708 times – based on 0 reviews     Review now
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            Development of the asthma control test: a survey for assessing asthma control.

            Robert A Nathan, Christine A Sorkness, Mark Kosinski … (2004)
            Asthma guidelines indicate that the goal of treatment should be optimum asthma control. In a busy clinic practice with limited time and resources, there is need for a simple method for assessing asthma control with or without lung function testing. The objective of this article was to describe the development of the Asthma Control Test (ACT), a patient-based tool for identifying patients with poorly controlled asthma. A 22-item survey was administered to 471 patients with asthma in the offices of asthma specialists. The specialist's rating of asthma control after spirometry was also collected. Stepwise regression methods were used to select a subset of items that showed the greatest discriminant validity in relation to the specialist's rating of asthma control. Internal consistency reliability was computed, and discriminant validity tests were conducted for ACT scale scores. The performance of ACT was investigated by using logistic regression methods and receiver operating characteristic analyses. Five items were selected from regression analyses. The internal consistency reliability of the 5-item ACT scale was 0.84. ACT scale scores discriminated between groups of patients differing in the specialist's rating of asthma control (F = 34.5, P <.00001), the need for change in patient's therapy (F = 40.3, P <.00001), and percent predicted FEV(1) (F = 4.3, P =.0052). As a screening tool, the overall agreement between ACT and the specialist's rating ranged from 71% to 78% depending on the cut points used, and the area under the receiver operating characteristic curve was 0.77. Results reinforce the usefulness of a brief, easy to administer, patient-based index of asthma control.
            Article 0 comments Cited 365 times – based on 0 reviews     Review now
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              Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial.

              Ruth H Green, Christopher E. Brightling, Susan Mckenna … (2002)
              Treatment decisions in asthma are based on assessments of symptoms and simple measures of lung function, which do not relate closely to underlying eosinophilic airway inflammation. We aimed to assess whether a management strategy that minimises eosinophilic inflammation reduces asthma exacerbations compared with a standard management strategy. We recruited 74 patients with moderate to severe asthma from hospital clinics and randomly allocated them to management either by standard British Thoracic Society asthma guidelines (BTS management group) or by normalisation of the induced sputum eosinophil count and reduction of symptoms (sputum management group). We assessed patients nine times over 12 months. The results were used to manage those in the sputum management group, but were not disclosed in the BTS group. The primary outcomes were the number of severe exacerbations and control of eosinophilic inflammation, measured by induced sputum eosinophil count. Analyses were by intention to treat. The sputum eosinophil count was 63% (95% CI 24-100) lower over 12 months in the sputum management group than in the BTS management group (p=0.002). Patients in the sputum management group had significantly fewer severe asthma exacerbations than did patients in the BTS management group (35 vs 109; p=0.01) and significantly fewer patients were admitted to hospital with asthma (one vs six, p=0.047). The average daily dose of inhaled or oral corticosteroids did not differ between the two groups. A treatment strategy directed at normalisation of the induced sputum eosinophil count reduces asthma exacerbations and admissions without the need for additional anti-inflammatory treatment.
              Article 0 comments Cited 319 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eur Respir Rev
                Journal ID (iso-abbrev): Eur Respir Rev
                Journal ID (publisher-id): ERR
                Journal ID (hwp): errev
                Title: European Respiratory Review
                Publisher: European Respiratory Society
                ISSN (Print): 0905-9180
                ISSN (Electronic): 1600-0617
                Publication date (Print): June 2015
                Volume: 24
                Issue: 136
                Pages: 361-369
                Affiliations
                [1 ]2nd Respiratory Medicine Dept, University of Athens Medical School, Attikon Hospital, Athens, Greece
                [2 ]7th Respiratory Medicine Dept and Asthma Center, Athens Chest Hospital “Sotiria”, Athens, Greece
                Author notes
                Mina Gaga, 7th Respiratory Dept and Asthma Center, Athens Chest Hospital “Sotiria”, Athens 11527, Greece. E-mail: minagaga@ 123456yahoo.com
                Article
                Publisher ID: ERR-0016-2015
                DOI: 10.1183/16000617.00001615
                PMC ID: 9487814
                PubMed ID: 26028647
                SO-VID: ac8c9358-6cd8-4e85-a2d3-982af26b7f09
                Copyright © Copyright ©ERS 2015.
                License:

                ERR articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                History
                Date received : 16 February 2015
                Date accepted : 05 March 2015
                Categories
                Subject: Series
                Subject: 2
                Series title: Number 3 in the series “Asthma” Edited by Pascal Chanez and Marc Humbert

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