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Related Experiment Videos

Difficult asthma

P J Barnes1, A J Woolcock

  • 1Dept of Thoracic Medicine, National Heart and Lung Institute, Imperial College, London, UK.

The European Respiratory Journal
|December 24, 1998
PubMed
Summary
This summary is machine-generated.

Approximately 5% of asthma patients have poorly controlled disease. Careful assessment is crucial to identify correctable factors, ensure accurate asthma diagnosis, and manage difficult-to-treat cases effectively.

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Area of Science:

  • Pulmonology
  • Allergy and Immunology
  • Respiratory Medicine

Background:

  • Asthma management is typically effective, but a small percentage of patients exhibit poor control despite high-dose inhaled corticosteroids.
  • Identifying and addressing correctable factors is essential for improving outcomes in these challenging cases.

Purpose of the Study:

  • To outline a systematic approach for assessing and managing patients with difficult-to-control asthma.
  • To emphasize the importance of accurate diagnosis, exclusion of other airway diseases, and identification of exacerbating factors.

Main Methods:

  • Careful patient assessment to confirm asthma diagnosis and rule out conditions like COPD or vocal cord dysfunction.
  • Identification and management of exacerbating factors such as allergens, occupational sensitizers, and gastro-oesophageal reflux.

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  • Optimization of corticosteroid therapy and consideration of additional controller medications or immunosuppressive treatments.

    • Main Results:

    • Poor adherence and unidentified exacerbating factors are common reasons for treatment failure.
    • Some patients exhibit asthma instability, steroid resistance, or progressive lung function decline.
    • Specialist supervision and comprehensive assessment, potentially including hospital admission, are recommended for difficult asthma.

    Conclusions:

    • Effective management of difficult asthma requires a thorough diagnostic process and individualized treatment strategies.
    • Addressing adherence, environmental triggers, and optimizing pharmacotherapy are key to improving patient control.
    • Future research into non-steroid anti-inflammatory treatments may offer new therapeutic options.