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

作者：Haughney John^*; Price David; Kaplan Alan; Chstyn Henry; Horne Rob; May Nick; Moffat Mandy; Versnel Jennifer; Shanahan Eamonn R; Hillyer Elizabeth V; Tunsater Alf; Bjermer Leif

来源：Respiratory Medicine, 2008, 102(12): 1681-1693.

DOI：10.1016/j.rmed.2008.08.003

• Asthma
• Nonadherence
• Poor control
• Primary care
• Smoking
• Tools

Achieving asthma control remains an elusive goat 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 suboptimal 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.

• 出版日期2008-12