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Choosing Inhaler Devices For People With Asthma: Current Knowledge And Outstanding Research Needs

 John Haughney,
Respiratory Medicine - DOI: 10.1016/j.rmed.2010.04.012


Achieving asthma control in practice: Understanding the reasons for poor control

John Haughney, David Price, Alan Kaplan, Henry Chrystyn, Rob Horne, Nick May, Mandy Moffat, Jennifer Versnel, Eamonn R. Shanahan, Elizabeth V. Hillyer, Alf Tunsäter, Leif Bjermer
Respiratory Medicine - December 2008 (Vol. 102, Issue 12, Pages 1681-1693, DOI: 10.1016/j.rmed.2008.08.003)
Published online 24 September 2008 by Respiratory Medicine. Click here.

Achieving asthma control remains an elusive goal for the majority of patients worldwide. Ensuring a correct diagnosis of asthma is the first step in assessing poor symptom control; this requires returning to the basics of history taking and physical examination, in conjunction with lung function measurement when appropriate. A number of factors may contribute to sub-optimal asthma control. Concomitant rhinitis, a common co-pathology and contributor to poor control, can often be identified by asking a simple question. Smoking too has been identified as a cause of poor asthma control. Practical barriers such as poor inhaler technique must be addressed. An appreciation of patients' views and concerns about maintenance asthma therapy can help guide discussion to address perceptual barriers to taking maintenance therapy (doubts about personal necessity and concerns about potential adverse effects). Further study into, and a greater consideration of, factors and patient characteristics that could predict individual responses to asthma therapies are needed. Finally, more clinical trials that enrol patient populations reflecting the real world diversity of patients seen in clinical practice, including wide age ranges, presence of comorbidities, current smoking, and differing ethnic origins, will contribute to better individual patient management.

IPCRG additional resources to accompany this article

(PDF files for numbers 2 and a-g below are available in full colour (main link) and black and white, allowing for printing using less ink)

  1. Achieving asthma control in practice: Understanding the reasons for poor control
  2. Achieving Asthma Control in Practice. Understanding the reasons for poor control: introduction.  
    (Black and white)
    1. Reasons for poor asthma control: have we made the wrong diagnosis?  Alan Kaplan  
      (Black and white)
    2. Reasons for poor asthma control: incorrect choice of inhaler, poor technique, Henry Chrystyn
       (Black and white)
    3. Reasons for poor asthma control: patients' beliefs and adherence, Rob Horne  
      (Black and white)
    4. The difficulty in capturing (and therefore demonstrating) subjective benefit in clinical trials, Nick May  
      (Black and white)
    5. Reasons for poor asthma control: individual variation in response to treatment, Leif Bjermer  
      (Black and white)
    6. Reasons for poor asthma control: smoking, David Price
      (Black and white)
    7. Reasons for poor asthma control: comorbid rhinitis, David Price
       (Black and white)
Can asthma control be improved by understanding the patients perspective?

A peer-reviewed article by IPCRG authors, Rob Horne, David Price, Jen Cleland, Rui Costa, Donna Covey, Kevin Gruffydd-Jones, John Haughney, Svein Hoegh Henrichsen, Alan Kaplan, Arnulf Langhammer, Anders Ostrem, Mike Thomas, Thys van der Molen, J Christian Virchow and Sian Williams.  BMC Pulmonary Medicine 2007, 7:8 (22 May 2007)
Click here

The IPCRG Users’ Guide to currently available asthma control tools   
  1. IPCRG Users' Guide (CCL "Some Rights Reserved")
  2. PDF file describing this material
  3. PDF file with table displaying rating of tools by selected criteria

 

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