Managing Asthma in Real Life: Defining What Really Matters

Dekhuijzen PNR, Kneussl M, Bateman E, Partridge M, Lavorini F, Virchow JC, Stowasser S, Steinkamp G. Managing Asthma in Real Life: Defining What Really Matters.  Annals of Respiratory Medicine, February 2010; 1(1):3-10

Review article

Richard Dekhuijzen¹, Meinhard Kneussl², Eric D Bateman³, Martyn R Partridge⁴, Federico Lavorini⁵, Christian Virchow⁶, S Stowasser⁷ and G Steinkamp⁸

Affiliations: ¹Radboud University Nijmegen Medical Centre, The Netherlands; ²Wilhelminenspital Vienna, Medical University Vienna, Austria; ³University of Cape Town, South Africa; ⁴Imperial College London, NHLI at Charing Cross Hospital, UK; ⁵University of Florence, Italy; ⁶University of Rostock, Germany; ⁷TEVA Pharmaceuticals Europe B.V., The Netherlands and ⁸Clinical Research and Medical Writing, Schwerin, Germany


ABSTRACT

Asthma control has become a focus in the treatment and follow‐up of patients. Division into good, partial, and poor control is operational and can be applied in daily practice, with support from validated questionnaires. Well‐controlled asthma can be achieved in a majority of patients in clinical trials, whereas epidemiological studies suggest that results may be different in “real life” settings. In health surveys, about half of patients with asthma were classified as uncontrolled, and many subjects were not receiving appropriate medication. Most major treatment studies are performed on highly selected groups and, as a result, represent only a small proportion of “real‐life” patients. A pragmatic approach to patients with inadequate asthma control is abbreviated by the acronym A‐B‐C‐D‐E: Is it really and only asthma? Are all bronchial triggers known? Is compliance optimal? Can the patient handle the device? Is every small airway reached? This scheme addresses the most frequent reasons for uncontrolled asthma and helps to explore possible underlying factors. With respect to compliance, physicians should elicit their patients’ information needs and concerns, involve patients in treatments decisions, support their self‐management, and provide patient‐centered care. Inhalation devices should be matched to the patient, and physicians should train patients in how to use the inhaler correctly. Because asthma is a disease of both large and small airways, targeting all airways more homogeneously with an extra‐fine HFA‐BDP formulation might improve asthma control and reduce asthma exacerbations in “real‐life” patients.

Keywords: Asthma control, Real life, Compliance, Inhalers, Small airways, Extra‐fine HFA‐BDP
Correspondence: Prof.P. N. Richard Dekhuijzen, Head, Dept. of Pulmonary Diseases (454), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Tel: +31 (0)243614579; e‐mail: R.Dekhuijzen@LONG.umcn.nl