Achieving asthma control in practice: Understanding the reasons for poor control

Abstract

Achieving asthma control remains an elusive goal for the majority of patients worldwide. Ensuring a correct diagnosis of asthma is the first step in assessing poor symptom control; this requires returning to the basics of history taking and physical examination, in conjunction with lung function measurement when appropriate. A number of factors may contribute to sub-optimal asthma control. Concomitant rhinitis, a common co-pathology and contributor to poor control, can often be identified by asking a simple question. Smoking too has been identified as a cause of poor asthma control. Practical barriers such as poor inhaler technique must be addressed. An appreciation of patients' views and concerns about maintenance asthma therapy can help guide discussion to address perceptual barriers to taking maintenance therapy (doubts about personal necessity and concerns about potential adverse effects). Further study into, and a greater consideration of, factors and patient characteristics that could predict individual responses to asthma therapies are needed. Finally, more clinical trials that enrol patient populations reflecting the real world diversity of patients seen in clinical practice, including wide age ranges, presence of comorbidities, current smoking, and differing ethnic origins, will contribute to better individual patient management.

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

“…[38][39][40][41] Guidelines highlight the importance of developing a partnership between the doctor and the patient [12][13][14]36 so that regular professional review and monitoring of people with asthma is combined with appropriate treatment recommendations and selfmanagement education to enable patients to achieve treatment goals. 42 The dual concepts of asthma severity and asthma control have been widely discussed.…”

“…[46][47][48][49][50][51][52][53][54] Although such questionnaires have been validated for research purposes, few have been validated for assessing individual asthma control in a clinical context. Suboptimal control is associated with concomitant rhinitis, other co-morbidities, smoking, poor inhaler technique and poor concordance with treatment, 40 but there is further need for studies enrolling patient populations seen in primary care to inform practice. 40 Management should reflect the heterogeneity of asthma.…”

“…Suboptimal control is associated with concomitant rhinitis, other co-morbidities, smoking, poor inhaler technique and poor concordance with treatment, 40 but there is further need for studies enrolling patient populations seen in primary care to inform practice. 40 Management should reflect the heterogeneity of asthma. Children and adults may have persistent or episodic asthma, triggered by viral infections, allergens or exercise.…”

Asthma management: stop, think and review before moving to step 3

“…Some patients are intentionally nonadherent, deciding not to take their medication because of concerns about safety or cost to them. 2 It is important to remember that patients' perceptions of the need for medication might differ from those of clinicians.…”

Improving clinician–patient communication in asthma: the HARP project

“…But progress at an individual, patient-clinician level is also necessary. The International Primary Care Respiratory Group (IPCRG) is committed to identifying reasons for poor asthma control in individuals (3,4). The Helping Asthma in Real People (HARP) initiative, which we describe here, is a practical implementation project (not a formal academic study) which seeks to start to address some of these issues using validated clinical assessment tools in real-life clinical practice.…”