Multidisciplinary expert discussion. Uncontrolled asthma: causes, consequences and possible solutions
DOI:
https://doi.org/10.23938/ASSN.0233Keywords:
Uncontrolled asthma. Treatment. Monitoring. Expert consensus. Delphi method.Abstract
Background. Numerous studies conclude that about half of the asthmatic population is not well controlled. The aim of this study was to discuss causes, consequences and possible solutions of uncontrolled asthma (UCA).
Methods. Discussion amongst asthma experts from the fields of Pneumology, Allergy and Primary Care, structured in three phases: 1) survey to get the opinion of participants involved in different areas of UCA; 2) expert meeting, in which the results of the survey were discussed, and the diagnosis, treatment and monitoring of UCA were presented and discussed; and, 3) with the main findings, 83 items were formulated and subjected to consensus among all participants through the Delphi method.
Results. There was consensus on 86.7% of the items in the Delphi questionnaire, mostly in terms of agreement.
Conclusions. The UCA analysis results show the need for future improvement in the following areas: to incorporate clinical performance protocols into asthma CPG to identify aggravating factors and comorbidities; to develop an inexpensive and easy-to-use tool to identify adherence; to establish patient phenotype; to analyse treatment side effects and to provide personalized treatment, especially assessing its efficacy and safety (symptom control and future risks). It is necessary to generate new evidence to determine additional tests to be used to monitor these patients.
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References
1. BARRANCO P, PEREZ-FRANCES C, QUIRCE S, GÓMEZ-TORRIJOS E, CÁRDENAS R, SÁNCHEZ-GARCÍA S et al. Consensus document on the diagnosis of severe uncontrolled asthma. J Investig Allergol Clin Immunol 2012; 22: 460-475.
2. Guía española para el manejo del asma (GEMA 2009) Available at http://www.gemasma.com/images/stories/GEMASMA/Documentos/GEMA%202009/index.html [Último acceso: 28 julio 2014]. 2009.
3. SCHATZ M. Predictors of asthma control: what can we modify? Curr Opin Allergy Clin Immunol 2012; 12: 263-268.
https://doi.org/10.1097/ACI.0b013e32835335ac
4. BEFEKADU E, ONOFREI C, COLICE GL. Tiotropium in asthma: a systematic review. J Asthma Allergy 2014; 7: 11-21.
https://doi.org/10.2147/JAA.S38841
5. From the Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2014. Available at: http://www.ginasthma.org/. [Último acceso; septiembre 2014].
6. VENNERA MD, PICADO C, HERRAEZ L, GALERA J, CASAFONT J, en nombre del Grupo de Estudio C. Factores asociados con el asma grave no controlada y la percepción de control por parte de médicos y pacientes. Arch Bronconeumol. 2014; 50: 384-391.
https://doi.org/10.1016/j.arbres.2014.03.002
7. Wechsler ME. Getting control of uncontrolled asthma. Am J Med. 2014; 127 :1049-1059.
https://doi.org/10.1016/j.amjmed.2014.05.006
8. CABALLERO MARTINEZ F, PLAZA V, QUIRCE GANCEDO S, FERNÁNDEZ BENÍTEZ M, GÓMEZ RUIZ F, LÓPEZ VIÑA A et al. Evaluación externa de las recomendaciones GEMA2009 por un panel de expertos multidisciplinario sobre el asma. Arch Bronconeumol 2010; 46: 411-419.
https://doi.org/10.1016/j.arbres.2010.05.004
9. DALKEY N BB, COCHRAN S. The Delphi Method, III: use of self ratings to improve group estimates. Rand Corporation 1969; RM-6115-PR.
10. DEMOLY P,ANNUNZIATA K,GUBBA E,ADAMEK L Repeated cross-sectional survey of patient-reported asthma control in Europe in the past 5 years. Eur Resp Rev 2012; 21: 66-74.
https://doi.org/10.1183/09059180.00008111
11. KITCH BT, PALTIEL AD, KUNTZ KM, DOCKERY DW, SCHOUTEN JP, WEISS ST et al. A single measure of FEV1 is associated with risk of asthma attacks in long-term follow-up. Chest 2004; 126: 1875-1882.
https://doi.org/10.1378/chest.126.6.1875
12. QUIRCE S, PLAZA V, PICADO C, VENNERA M, CASAFONT J. Prevalence of uncontrolled severe persistent asthma in pneumology and allergy hospital units in Spain. J Investig Allergol Clin Immunol 2011; 21: 466-471.
13. JIA CE, ZHANG HP, LV Y, LIANG R, JIANG YQ, POWELL H et al. The asthma control test and asthma control questionnaire for assessing asthma control: systematic review and meta-analysis. J Allergy Clin Immunol 2013; 131: 695-703.
https://doi.org/10.1016/j.jaci.2012.08.023
14. American Thoracic S, European Respiratory S. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med 2005; 171: 912-930.
https://doi.org/10.1164/rccm.200406-710ST
15. DUPONT LJ, DEMEDTS MG, VERLEDEN GM. Prospective evaluation of the validity of exhaled nitric oxide for the diagnosis of asthma. Chest 2003; 123: 751-756.
https://doi.org/10.1378/chest.123.3.751
16. SAITO J, SATO S, FUKUHARA A, SATO Y, NIKAIDO T, INOKOSHI Y et al. Association of asthma education with asthma control evaluated by asthma control test, FEV1, and fractional exhaled nitric oxide. J Asthma 2013; 50: 97-102.
https://doi.org/10.3109/02770903.2012.741638
17. GERSHON AS, WANG C, GUAN J, TO T. Burden of comorbidity in individuals with asthma. Thorax 2010; 65: 612-618.
https://doi.org/10.1136/thx.2009.131078
18. HERNANDO CG. Tomografía axial computarizada en el asma. Rev Pat Resp 2007; 10: 2-?
19. KIM Y, EVANGELISTA LS. Relationship between illness perceptions, treatment adherence, and clinical outcomes in patients on maintenance hemodialysis. Nephrol Nurs J 2010; 37: 271-280.
20. Adherencia a los tratamientos a largo plazo Ppla, OMS 2004. Disponible en http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=18722&Itemid= [Último acceso 30 de julio 2014].
21. VAN LIESHOUT RJ, MACQUEEN GM. Relations between asthma and psychological distress: an old idea revisited. Chem Immunol Allergy 2012; 98: 1-13.
https://doi.org/10.1159/000336493
22. MOLDRUP C, STEIN J, SONDERGAARD B. Patients don't lie; a view on adherence in asthma. Pharm World Sci 2010; 32: 795-798.
https://doi.org/10.1007/s11096-010-9439-0
23. KERSTJENS HA, ENGEL M, DAHL R, PAGGIARO P, BECK E, VANDEWALKER M et al. Tiotropium in asthma poorly controlled with standard combination therapy. N Engl J Med 2012 ; 367: 1198-1207.
https://doi.org/10.1056/NEJMoa1208606
24. PADULLES ZAMORA N, COMAS SUGRANES D, MENDEZ CABALEIRO N, FIGUERAS SURIOL A, JODAR MASANES R. Análisis restrospectivo de omalizumab en pacientes con asma alérgica severa. Farm Hosp 2013; 37: 399-405.
25. SEVILLA-SÁNCHEZ D, SOY-MUNER D, SOLER-PORCAR N. Utilidad de los macrólidos como antiinflamatorios en enfermedades respiratorias. Arch Bronconeumol 2010; 46: 244-254.
https://doi.org/10.1016/j.arbres.2009.10.008
26. SASTRE J, OLAGUIBEL J, VEGA JM, DEL POZO V, PICADO C, LOPEZ VINA A. Los puntos de corte para definir el control del asma en tres versiones del Cuestionario de Control del Asma. J Asthma 2010; 47: 865-870.
https://doi.org/10.3109/02770903.2010.491149
27. BATEMAN ED, JACQUES L, GOLDFRAD C, ATIENZA T, MIHAESCU T, DUGGAN M. Asthma control can be maintained when fluticasone propionate/salmeterol in a single inhaler is stepped down. J Allergy Clin Immunol 2006; 117: 563-570.
https://doi.org/10.1016/j.jaci.2005.11.036
28. PETSKY HL, CATES CJ, LASSERSON TJ, LI AM, TURNER C, KYNASTON JA et al. A systematic review and meta-analysis: tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils). Thorax 2012; 67: 199-208.
https://doi.org/10.1136/thx.2010.135574
29. VOLLMER WM, SWAIN MC. Role of the specialist in the treatment of asthma. Curr Opin Allergy Clin Immunol 2002; 2: 189-194.
https://doi.org/10.1097/00130832-200206000-00006
30. GREENBERG S. Asthma exacerbations: predisposing factors and prediction rules. Curr Opin Allergy Clin Immunol 2013; 13: 225-236.
https://doi.org/10.1097/ACI.0b013e32836096de
31. FUHLBRIGGE A, PEDEN D, APTER AJ, BOUSHEY HA, CAMARGO CA JR, GERN J et al. Asthma outcomes: exacerbations. J Allergy Clin Immunol 2012; 129: S34-S48.
https://doi.org/10.1016/j.jaci.2011.12.983
32. CONTHE P, MARQUEZ CONTRERAS E, ALIAGA PEREZ A, BARRAGÁN GARCÍA B, FERNÁNDEZ DE CANO MARTÍN MN, GONZÁLEZ JURADO M et al. El cumplimiento del tratamiento en la enfermedad crónica : Situación actual y perspectivas futuras. Rev Clin Esp 2014; 214: 336-344.
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