Page 131 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 131
e severe airway obstruction and greater Dilemmas in Severe Asthma 131
hyper-responsiveness32.
First Dilemma: How Could we Precisely controversies and dilemmas in severe asthma
It is obvious that smoking negatively in- Define a Severe Asthma Phenotype?
fluences asthma -it aggravates symptoms and
treatments for exacerbation, increases inflam- The real-world situation in medical praxis is
mation and decreases the possibility of asth- concerning. Around half (1/2) of the physi-
ma control. That is why physicians and all cians in the world do not have an approach
other health care professionals should ex- to diagnostic tools satisfying for establish-
ert the greatest effort to bring the awareness ing an accurate diagnosis. Around one third
about harmful effects of tobacco smoking to (1/3) of the patients in the world receive in-
our patients. appropriate treatment, and around one quar-
ter (¼) of patients have potential life-threat-
It is important to build a national capac- ening side-effects because of inappropriate
ity for smoking cessation policy, which the treatment.
World Health Organization (WHO) summa-
rizes in a document33. There are enumerated Today, defining severe asthma pheno-
measures influencing the demand for tobac- types is a process based on a biomarker-driv-
co products (like taxation and legislation) and en approach35. Asthma phenotypes with un-
other interventions directly targeted to facili- derlying mechanisms became the centre of
tate the changes in tobacco user attitudes and asthma research as there are efficient pheno-
behaviour (like Quit and Win competition, type-driven therapies available. This thera-
mass media communications campaign, tele- py is usually biological36, 37, but also includes
phone help-line etc.). At the individual level macrolides, which are a successful therapy
the most recommended is the 5A strategy34: in uncontrolled asthma38 (although the im-
munomodulatory effect of azithromycin was
1. Ask: Identify and document the tobac- proven more than a decade ago in healthy
co-use status of every patient at every persons39) and other airways diseases such as
visit. chronic obstructive pulmonary disease,
2. Advis: In a clear, strong, and personal- Precisiondefinition of severe asthma phe-
ized manner, urge every tobacco user to notype is crucial for applying personalized
quit. medicine40.
3. Assess: Is the tobacco user willing to For that purpose, we should combine
make a quit attempt at this time? medical history, physical examination, bio-
markers and imaging methods. In medical
4. Assist: For the patient willing to make a history the most important is the age when
quit attempt, use counselling and phar- an asthma diagnosis was established. Other
macotherapy to help him or her quit. factors to take into consideration are: wheth-
er it is childhood or adulthood asthma (ear-
5. Arrange: Schedule follow-up contact, ly-onset or late-onset asthma), if there are
preferably within the first week after the allergies or any drug sensitivities, is there a
quit date, in person or by telephone. family history of allergies, is there a smoking
habit or obesity present, which comorbidities
It would take only a few minutes to speak does the patient have, especially nasal polyps,
to patients and learn about their tobacco use and carefully monitoring of a steroid side ef-
and habits. We should help the smoker to un- fect, like arterial hypertension, diabetes mel-
derstand the health risks of smoking. Tobac- litus, depression, adrenal insufficiency or cat-
co is the single greatest preventable cause of aracts. Among biomarkers for clinical praxis,
disease and premature death. Stop smoking the most important are total and specific
is the best thing one could do for his or her
health.
hyper-responsiveness32.
First Dilemma: How Could we Precisely controversies and dilemmas in severe asthma
It is obvious that smoking negatively in- Define a Severe Asthma Phenotype?
fluences asthma -it aggravates symptoms and
treatments for exacerbation, increases inflam- The real-world situation in medical praxis is
mation and decreases the possibility of asth- concerning. Around half (1/2) of the physi-
ma control. That is why physicians and all cians in the world do not have an approach
other health care professionals should ex- to diagnostic tools satisfying for establish-
ert the greatest effort to bring the awareness ing an accurate diagnosis. Around one third
about harmful effects of tobacco smoking to (1/3) of the patients in the world receive in-
our patients. appropriate treatment, and around one quar-
ter (¼) of patients have potential life-threat-
It is important to build a national capac- ening side-effects because of inappropriate
ity for smoking cessation policy, which the treatment.
World Health Organization (WHO) summa-
rizes in a document33. There are enumerated Today, defining severe asthma pheno-
measures influencing the demand for tobac- types is a process based on a biomarker-driv-
co products (like taxation and legislation) and en approach35. Asthma phenotypes with un-
other interventions directly targeted to facili- derlying mechanisms became the centre of
tate the changes in tobacco user attitudes and asthma research as there are efficient pheno-
behaviour (like Quit and Win competition, type-driven therapies available. This thera-
mass media communications campaign, tele- py is usually biological36, 37, but also includes
phone help-line etc.). At the individual level macrolides, which are a successful therapy
the most recommended is the 5A strategy34: in uncontrolled asthma38 (although the im-
munomodulatory effect of azithromycin was
1. Ask: Identify and document the tobac- proven more than a decade ago in healthy
co-use status of every patient at every persons39) and other airways diseases such as
visit. chronic obstructive pulmonary disease,
2. Advis: In a clear, strong, and personal- Precisiondefinition of severe asthma phe-
ized manner, urge every tobacco user to notype is crucial for applying personalized
quit. medicine40.
3. Assess: Is the tobacco user willing to For that purpose, we should combine
make a quit attempt at this time? medical history, physical examination, bio-
markers and imaging methods. In medical
4. Assist: For the patient willing to make a history the most important is the age when
quit attempt, use counselling and phar- an asthma diagnosis was established. Other
macotherapy to help him or her quit. factors to take into consideration are: wheth-
er it is childhood or adulthood asthma (ear-
5. Arrange: Schedule follow-up contact, ly-onset or late-onset asthma), if there are
preferably within the first week after the allergies or any drug sensitivities, is there a
quit date, in person or by telephone. family history of allergies, is there a smoking
habit or obesity present, which comorbidities
It would take only a few minutes to speak does the patient have, especially nasal polyps,
to patients and learn about their tobacco use and carefully monitoring of a steroid side ef-
and habits. We should help the smoker to un- fect, like arterial hypertension, diabetes mel-
derstand the health risks of smoking. Tobac- litus, depression, adrenal insufficiency or cat-
co is the single greatest preventable cause of aracts. Among biomarkers for clinical praxis,
disease and premature death. Stop smoking the most important are total and specific
is the best thing one could do for his or her
health.
