Page 47 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 47
lowing comprehensive assessment, a large patients with problematic asthma have poten- 47
proportion of patients with more problematic tially modifiable treatable factors if those are
asthma actually fall into the category of dif- identified through an appropriate compre- the multi-disciplinary team approach to specialist adult difficult asthma care
ficult rather than severe asthma. Two recent hensive and holistic assessment process.
European studies have highlighted this point.
In a study of 1034 asthma patients attending Difficult Asthma as a Multimorbidity
4 respiratory clinics in Denmark, 17% were Difficult Breathing Syndrome
classified as having difficult asthma follow- – The Concept of Treatable Traits
ing application of ERS/ATS criteria for dif-
ficult asthma based on treatment levels. In Clinicians readily acknowledge that a pro-
those subjects after a systematic assessment portion of patients with asthma do not attain
process, only 12% fulfilled the stringent crite- good asthma control despite full optimisation
ria for severe asthma in isolation, while 56% with currently available asthma treatments.
fell into the category of difficult asthma and This concerning fact was the focus of a Lan-
32% had overlapping features of both19. In cet 2017 Commission “After asthma: redefin-
a Dutch pharmacy database study of adult ing airways disease”.21 In addition the realisa-
asthma patients, 17.4% met criteria for hav- tion is dawning that poorly controlled asthma
ing difficult asthma. Following an Innovative seldom occurs as an isolated health problem.
Medicine Initiative (IMI) definition based on In particular at the more “difficult-to-con-
adherence and good inhaler technique to dis- trol” end of the spectrum asthma often con-
tinguish those with severe refractory asthma, stitutes part of a multimorbidity constellation
only 20.5% of these difficult asthmatics were of conditions best regarded as a “Difficult
deemed to have severe asthma20. These find- Breathing Syndrome” rather than “severe
ings collectively signal the point that most asthma” alone (Figure 1). This has led to
the need to adopt a more holistic perspective
Figure 1. The “Difficult breathing syndrome” in difficult asthma.
Abbreviations: T2 – Type 2 inflammation, ABPA – Allergic Bronchopulmonary Aspergillosis,
SAFS – S evere Asthma with Fungal Sensitisation, COPD – Chronic Obstructive Pulmonary Disease,
GORD – Gastro-o esophageal reflux disease.
proportion of patients with more problematic tially modifiable treatable factors if those are
asthma actually fall into the category of dif- identified through an appropriate compre- the multi-disciplinary team approach to specialist adult difficult asthma care
ficult rather than severe asthma. Two recent hensive and holistic assessment process.
European studies have highlighted this point.
In a study of 1034 asthma patients attending Difficult Asthma as a Multimorbidity
4 respiratory clinics in Denmark, 17% were Difficult Breathing Syndrome
classified as having difficult asthma follow- – The Concept of Treatable Traits
ing application of ERS/ATS criteria for dif-
ficult asthma based on treatment levels. In Clinicians readily acknowledge that a pro-
those subjects after a systematic assessment portion of patients with asthma do not attain
process, only 12% fulfilled the stringent crite- good asthma control despite full optimisation
ria for severe asthma in isolation, while 56% with currently available asthma treatments.
fell into the category of difficult asthma and This concerning fact was the focus of a Lan-
32% had overlapping features of both19. In cet 2017 Commission “After asthma: redefin-
a Dutch pharmacy database study of adult ing airways disease”.21 In addition the realisa-
asthma patients, 17.4% met criteria for hav- tion is dawning that poorly controlled asthma
ing difficult asthma. Following an Innovative seldom occurs as an isolated health problem.
Medicine Initiative (IMI) definition based on In particular at the more “difficult-to-con-
adherence and good inhaler technique to dis- trol” end of the spectrum asthma often con-
tinguish those with severe refractory asthma, stitutes part of a multimorbidity constellation
only 20.5% of these difficult asthmatics were of conditions best regarded as a “Difficult
deemed to have severe asthma20. These find- Breathing Syndrome” rather than “severe
ings collectively signal the point that most asthma” alone (Figure 1). This has led to
the need to adopt a more holistic perspective
Figure 1. The “Difficult breathing syndrome” in difficult asthma.
Abbreviations: T2 – Type 2 inflammation, ABPA – Allergic Bronchopulmonary Aspergillosis,
SAFS – S evere Asthma with Fungal Sensitisation, COPD – Chronic Obstructive Pulmonary Disease,
GORD – Gastro-o esophageal reflux disease.
