A gap between asthma guidelines and actual management
Published online: June 6, 2020
Most patients with asthma have mild or moderate disease. With currently available medications, the majority can be treated effectively if patients adhere to the treatment. The long-term goal of asthma treatment is to achieve control of symptoms and maintain normal activity levels. It is therefore important to regularly monitor symptom control, risk factors, and response to treatment through follow-up visits performed by an appropriate suitable healthcare provider at an appropriate level of care. At around age 18 years, management involves a transition from paediatric to adult healthcare. Even though formal transition guidelines exist, previous literature have shown that the transition from paediatric to adult healthcare is often haphazard, e.g., when the transition has not been planned appropriately with a risk that the young adults lose contact with follow-up after the transfer to adult healthcare.
In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Ödling et al. investigated asthma-related healthcare consumption and pharmacological dispensation during the transition from paediatric to adult healthcare. A longitudinal approach was used to follow different asthma phenotypes during the entire transition process. In the Swedish birth cohort, questionnaire and clinical data from the 16- and 24-year follow-ups were linked to national and regional registries for asthma-related healthcare consumption and dispensed medications during an eight-year period: four years before and after age 18 years, respectively.
The study showed that almost two thirds of the young adults with persistent asthma had not had any follow-up visit after age 18 years. For all asthma phenotypes, healthcare consultations were fewer than recommended in guidelines, and their frequency decreased after the transition. The dispensations of asthma medications decreased after the transition, even for the participants with severe asthma. For all asthma phenotypes, almost no one had dispensed regular asthma medications during the eight-year period. The study showed that there is a gap between asthma guidelines and actual management. Increased adherence to current guidelines is required when planning for optimal care of adolescents and young adults, including their transition to adult healthcare.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.