Tailored asthma management strategies in primary care

Published Online: August 28, 2014

Currently the aim of asthma management is control of clinical manifestations, which means experiencing few, or no symptoms for prolonged periods of time. Although theoretically this should reduce the burden of asthma, it may also lead to the need for high doses of medication, with an associated risk of side-effects, reduced medication-adherence, and increased costs. Since patient safety—including prevention of exacerbations and side-effects of medication—and keeping in check the cost of treatment are also important goals, a less stringent aim of asthma control might balance pros and cons more efficiently. Additionally, in the treatment of individual patients no clear practical guidelines exist regarding which type of asthma medication is preferred in a particular situation. A relatively new device that measures airway inflammation (FeNO-device) might help determine what type of medication is preferable in individual cases.

In a study recently published in The Journal of Allergy and Clinical Immunology (JACI), P.J. Honkoop and colleagues present the results of their trial, where they compared the quality of life, asthma symptom level, exacerbation-rate, patient preferences, and cost of three asthma management strategies. The first strategy was aimed at ‘Controlled asthma’; the second at ‘Partly Controlled asthma’, which allowed mild symptoms before increasing treatment; and the third was aimed at ‘FeNO Controlled asthma’ and additionally used the results of the FeNO-device to make treatment decisions.

The authors of this study treated over 600 adult primary care asthma patients during the course of a year. An online decision support tool was used by Practice Nurses every three months to obtain automated treatment advice for an individual patient based on that patient’s management strategy, current medication, symptoms, lung function, and if applicable, FeNO results. In order to study the optimal asthma management strategy, patients filled out multiple online questionnaires on quality of life, adherence, symptoms, and costs.

With this study the authors were able to demonstrate that aiming for ‘Partly Controlled asthma’ leads to similar levels of quality of life, severe exacerbation-rates, and asthma symptoms as ‘Controlled asthma’, but with significantly less asthma medication use and lower costs. The ‘FeNO Controlled asthma’ was the best strategy. It also significantly reduced asthma medication use compared to ‘Controlled asthma’. In addition, it resulted in significantly fewer asthma symptoms than the ‘Partly Controlled asthma’ strategy, and it was the most cost-effective of the three strategies.

The author’s findings suggest that using a FeNO-device—in addition to symptoms and lung function monitoring—to tailor treatment decisions improves clinical and societal asthma outcomes in primary care.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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