Uncontrolled Asthma: Unmet Needs in the Management of Patients

Abstract

The recent scientific research has provided clinicians with the tools for substantially upgrading the standard of care in the field of bronchial asthma. Nevertheless, satisfactory asthma control still remains an unmet need worldwide. Identifying the major determinants of poor control in different asthma severity levels represents the first step towards the improvement of the overall patients’ management. The present review aims to provide an overview of the main unmet needs in asthma control and of the potential tools for overcoming the issue. Implementing a personalized medicine approach is essential, not only in terms of pharmacological treatments, biologic drugs or sophisticated biomarkers. In fact, exploring the complex profile of each patient, from his inflammation phenotype to his preferences and expectations, may help in filling the gap between the big potential of currently available treatments and the overall unsatisfactory asthma control. Telemedicine and e-health technologies may provide a strategy to both optimize disease assessment on a regular basis and enhance patients’ empowerment in managing their asthma. Increasing patients’ awareness as well as the physicians’ knowledge about asthma phenotypes and treatment options besides corticosteroid probably represent the key and more difficult goals of all the players involved in asthma management at every level.

Patients With Severe Asthma Need Accurate Diagnosis and Correct Treatment: How Can We Achieve That?

“…Cumulative annual OCS exposure as little as 0.5-1 gram (2-4 lifetime courses) was associated with serious adverse events (AE). 10,11 These findings [8][9][10][11] further stress the importance of improving patient awareness on OCS-related adverse effects (AEs) and support the need for optimizing asthma treatments (ICS-LABA, long-acting muscarinic agonists (LAMA) and biologic therapies) to reduce exposure to OCS.…”

“…7 Overuse of OCS is also associated with a significant risk of systemic side effects. 8 As many as 93 percent and 60 percent of patients with severe or difficult-to-treat asthma have received short-and long-term OCS treatment in the past 12 months, respectively. 9 Hypertension, osteoporosis, cataract, diabetes, respiratory infections, and cardiovascular events represent some of the OCS-related major adverse events described in severe asthmatics.…”

“…9 Hypertension, osteoporosis, cataract, diabetes, respiratory infections, and cardiovascular events represent some of the OCS-related major adverse events described in severe asthmatics. 8 A seven-year observational study conducted by Price et al 10 in a broad asthma population (initiating OCS) reported that increasing cumulative exposure and mean daily exposure to OCS significantly places patients at a high risk of potentially life-changing OCS-related adverse outcomes. Cumulative annual OCS exposure as little as 0.5-1 gram (2-4 lifetime courses) was associated with serious adverse events (AE).…”

Severe Asthma, Telemedicine, and Self-Administered Therapy: Listening First to the Patient

“…However, the recent development of inhaler trackers assessing the real-time usage of inhaled drugs may represent a step forward in achieving a better adherence to asthma treatment at any level of severity. The empowering of patients', which represents a crucial step for achieving an optimal asthma control, can be implemented by e-health technologies and telemedicine, including the availability of digital apps providing warning notifications [9,10]. The patient's perception and judgement about the management of their disease through telemedicine tools represents an underestimated issue.…”

Using Telemedicine to Care for the Asthma Patient

“…However, it can be used for other professionals involved in the care of asthmatics as well (i.e., community pharmacies, asthma educators, emergency rooms, school nurses, etc.) In fact, pharmacists should be heavily involved since many patients rely on them for their asthma medications more than the medical follow-up visit [ 44 ].…”