A Practical Guide to Improve Difficult-to-Manage Asthma in Primary Care
Endorsed by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA)
Studies estimate that in primary care about one out of every six people living with asthma have difficult-to-manage asthma, and of those, between a quarter and a half will have severe asthma. Having difficult-to-manage asthma puts people at higher risk of exacerbations and even death, which are preventable with effective management. Similarly, they are at greater risk of steroid-related adverse effects (if treated with high-dose ICS or avoidable courses of OCS or low-dose OCS over some time), and their morbidity and health costs are disproportionately higher. People with well-controlled asthma have a better quality of life, reduced symptoms and exacerbations, reduced hospital visits and admissions and lower risk of premature death. But most importantly, difficult-to-manage asthma can be managed using a structured approach.
Difficult-to-manage asthma occurs either when the person or their clinician finds control and treatment challenging, despite the (apparent) best possible treatment. This leads to the person facing difficulties dealing with some of the following:
- Daytime asthma symptoms, more than twice/week
- Any night awakening due to asthma-related symptoms
- More than two exacerbations per year requiring rescue systemic corticosteroids
- Frequent use of SABA (≥3 canisters per year or ≥3 times per week)
- Poor control despite prescription of high-dose ICS often in combination with LABA/LAMA or use of OCS
- Frequent primary care out-of-hours contacts (one or more per month).
Co-Authors: Jaime Correia de Sousa, Dermot Ryan, Garry McDonald, Hanna Sandelowsky, Katarina Stavric, Liam G Heaney, LuÃs Carvalho, Siân Williams
