About 8 million people in the United States currently have asthma. The Centers for Disease Control and Prevention estimates that at least 10,000 new cases of asthma and 15,000 deaths occur annually in American women and men.
Many adults with asthma have a variety of co-morbidities, making asthma management difficult. However, a number of effective medications can be prescribed, and patient education and referral to specialty providers are common strategies for managing asthma.
Asthma is a common breathing difficulty characterized by intermittent airway obstruction due to inflammation, airway remodelling and variable airflow limitation. Asthma often begins in childhood with an increased respiratory vulnerability and may be the first manifestation of asthma in many people. It is highly variable in its effects but can be severely debilitating when uncontrolled.
The best available evidence suggests that the risk of death associated with asthma is largely due to the underlying disease, rather than some characteristic of the disease that is controllable. However, recent studies have shown that asthma can be cured, and in fact many patients benefit from anti-inflammatory treatment.
Many factors, such as age, smoking, and allergic disease increase the risk of developing asthma. However, in some cases the underlying factor is genetic susceptibility. Most people with asthma have a combination of triggers and susceptibility.\n
Asthma was often under-recognised until the presentation of children to the paediatric emergency department, or even after admission to hospital. The classic signs are wheezing, shortness of breath and coughing up blood. It is important to understand the underlying signs/symptoms of asthma as children with little/no symptoms may present acutely with asthma if they can't breathe enough air.
Physicians have a responsibility to promote and educate patients as to clinical trials. Patients may feel less anxious if they are informed that the benefits of pharmaceutical treatments outweigh the risks. The process of informed consent regarding clinical trials is simple, and patient-centric approaches to care make clinical trials more acceptable. Physicians must promote patient-centered clinical trials as they continue to provide patients with the most current evidence on treatment options.
Current usual care for patients with asthma is suboptimal and involves only a small part of the patient's symptomatology. At present, we recommend increasing the use of usual care interventions, especially for people with more severe symptoms.
Asthma can be prevented and controlled by reducing dietary, physical, and psychosocial factors. The most serious factors are smoking, obesity, and environmental irritants, such as dust and air pollution.
Although the group with usual care did not lose more weight than those on placebo, the weight gain seen was a better reflection of the weight loss they were able to achieve. This is because weight gain can only follow weight loss. For BMI > 35 to decrease, other factors have to be targeted, such as the high fat density diet.
Although the majority of healthcare professionals were satisfied with the current level of care, some felt that a more integrated model of outpatient asthma management was needed. One aspect that needs greater integration is improving the quality of the patients’ lifestyle, including lifestyle advice.
Few patients received ICS therapy alone or with other treatments. This was particularly true for patients who had been prescribed a LABA. This finding suggests that clinicians may be missing opportunities to improve asthma outcomes by using effective combinations of therapy to reduce exacerbations and improve lung function and QoL.