Dumping the age-old focus on treating asthma symptoms as well as improving risk stratification and having sanctions for non-compliance with guidelines, will be crucial to improving asthma outcomes, respiratory experts in the UK have suggested.
Writing in The Lancet, Respiratory Consultants Professor Andrew Bush and Professor Ian Pavord highlighted the huge discordance between having “excellent, evidence-based guidelines” but poor asthma outcomes.
Addressing this evidence-practice gap must be a priority for parties currently shaping new guidelines on the diagnosis, monitoring and management of chronic asthma, they said.
In clinical practice there needs to be a move away from the focus on symptoms as a basis for treatment, and to focus instead of treating asthma traits, they suggested.
As well, significant improvement is needed in risk stratification to reduce asthma overdiagnosis and identify and reach those patients most at risk, and also in monitoring of adherence as a means to ensuring that patients are receiving the right therapy.
In their Lancet comment, Professors Pavord and Bush stressed that “symptom-guided treatment with up and down titration, which led to many patients receiving unnecessary high doses of [inhaled corticosteroid], has been a central tenet of asthma management guidelines and must be discarded”.
Instead, a greater focus on measurement will help to determine what type of asthma is present, and thus how best to treat it, they said.