For patients with uncontrolled persistent asthma, disease management focusing on exacerbation reduction may fail to address key limitations and concerns. In addition to higher exacerbation rates, impaired lung function, risk of long-term side effects from OCS and poor QoL are significant factors of disease burden and long-term health risks for these patients. Optimal asthma control should focus on comprehensive care, including improving lung function.
Asthma diagnosis is difficult; being a clinical syndrome there is no gold standard for diagnosis. Diagnosis should not be based solely on clinical characteristics but should incorporate a combination of clinical symptoms and the physiological manifestations including reversible airflow limitation and/or airway hyper-responsiveness.1
There is no single test that can be administered to definitively diagnose asthma, however a combination of methods are used to determine its likelihood in a patient. This includes measuring airflow obstruction (spirometry and peak flow); assessing reversibility with bronchodilators and testing for airway inflammation. Additional methods of testing include skin or blood prick tests determining allergic responses to the environment and measures of airway hyperactivity.1
The test (or combination of tests) that can most accurately diagnose asthma is still a topic of debate.1
Patients with uncontrolled persistent asthma may experience high exacerbation rates, impaired lung function, risk of long-term OCS side effects, and poor QoL.2–6
Exacerbations were 3 times more likely to occur in patients with uncontrolled asthma than in those with better asthma control2
Airway remodelling, often driven by persistent Type 2 inflammation, can lead to impaired lung function in both the large and small airways8–10
Due to the potential for substantial side effects with OCS use, guidelines suggest not using OCS as maintenance therapy until all other pharmacologic options have been exhausted4,11,12
Long-term use of OCS has been associated with osteoporosis, arterial hypertension, diabetes and metabolic syndrome, dyslipidaemia, obesity, cataracts, glaucoma, gastrointestinal bleeds/ulcers, tuberculosis, depression, herpes, and sepsis6
Patients miss out on outdoor, physical, and other daily activities13
Anxiety and depression worsen symptoms and complicate disease management5
There remains an unmet need to provide comprehensive care for patients with uncontrolled persistent asthma, including:2,4,12,14
Lung function is critical to the assessment of future risk in patients with asthma12
In 2017, the National Institute of Health and Care Excellence developed guidance for the diagnosis, monitoring and management of chronic asthma. The guidance is projected to save approximately 12 million pounds per year across England in pre-implementation costs.1
Learn about the key drivers of
Type 2 inflammation.
Learn about the prevalence and
healthcare burden of asthma.
Type 2 inflammation has been associated with several chronic conditions. Find out how they can present additional challenges.Learn about comorbidities
BDR, bronchodilator reversibility; FeNO, fractional exhaled nitric oxide; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; IgE, immunoglobulin E; NICE, The National Institute of Health and care Excellence; OCS, oral corticosteroids; PC20, provocative concentration of methacholine causing a 20% fall in FEV1; ppb, parts per billion; QoL, quality of life.References: