Managing asthma: an evidence-based approach to optimizing inhaled corticosteroid treatment

Asthma is a chronic disease characterized by airway inflammation and hyperresponsiveness and is associated with significant yet avoidable mortality and morbidity resulting in considerable individual and societal burden. Inhaled corticosteroids are the most effective class of controller medication available today for treating persistent asthma and are the evidence-based guideline-recommended first-line treatment for controlling asthma. Although inhaled corticosteroids have proven to reduce asthma-related exacerbations that lead to hospitalizations and death, recent studies have shown that only a small percentage of patients receive appropriate treatment and monitoring for their asthma. Delivering optimal asthma management requires an understanding and application of basic science and evidence-based guidelines in clinical practice. Management of a chronic disease in the primary care setting requires overcoming several barriers due to competing priorities and time constraints of the physician, as well as the reluctance of patients to actively participate in their own care. However, evidence has shown that the patient-centered medical home model can overcome some of these issues and improve patient outcomes and adherence to therapy.