Therapy and Management | Management | Overview

Problems in asthma control

Despite effective treatment regimens asthma, the most common chronic disease in industrialized countries, is still poorly controlled. This may be attributed to a failure to recognize asthma as a diagnosis, missing implementation of asthma management guidelines and patient non-compliance with therapy.

According to the GINA (Global Initiative for Asthma) guidelines asthma is controlled when patients have rare chronic symptoms, only few exacerbations, no emergency visits, minimal use of β2-agonists, no limitation of their activity levels, circadian variation in PEF < 20%, PEF near normal and minimal adverse events from medication.

Global Asthma Insights and Reality (AIR) surveys revealed that – despite single regional differences – all over the world the GINA goals have not been achieved yet. This may be caused by limitations of the guidelines themselves, which for example do not take into account variation in availability and cost of treatment in different countries. They are long and therefore not rapidly understood and incorporated.

On the other hand patient compliance may be reduced due to drug-related and non-drug factors. These include difficulties in using the inhalation devices, following complex treatment regimens, understanding the instructions or emotional barriers like worrying about side effects. Therefore the implementation of guidelines should be increased considering additional factors not referred to in the guidelines in order to improve the individual management of asthma patients.

Literature:

Barnes PJ. The size of the problem of managing asthma. 2004. Respiratory Medicine; 98 (Suppl.2): S4-S8

O'Byrne P. GINA Executive Commitee. Global strategy for asthma management and prevention. 2004. National Institutes of Health. Publication No 02-3659

Rabe K, Vermeire P, Soriano J, Maier W. clinical management of asthma in 1999: the Asthma Insights and Reality in Europe (AIRE) study. 2000. European Respiratory Journal; 16: 802-807

Failure in reaching the goals of asthma management

Adapted from:
Rabe KF, Adachi M, Lai CKW, Soriano JB, Vermeire PA, Weiss KB, Weiss ST. Worldwide severity and control of asthma in children and adults. The global Asthma Insights and Reality surveys. 2004. Journal of Allergy and Clinical Immunology; 114 (1): 40-47

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