Difficult-to-treat asthma : a multidimensional approach before considering targeted therapy

Poor control in patients with difficult-to-treat asthma might be due to several factors, including poor adherence and undertreated asthma co-morbidities. After an assessment addressing these issues, only few patients still need targeted therapy.We aimed to evaluate the effect of a multidimensional intervention in improvement asthma control in patients with difficult asthma.Fifty patients with difficult asthma were prospectively included in this study conducted in AbderrahmenMami hospital between March 2018 and September 2018. Clinical, biological and functional characteristics were collected. Then, coexisting conditions (poor adherence, allergens exposure, chronic rhinosinusitis, gastro-oesophageal reflux, obesity, obstructive sleep apnea syndrome, anxiety and depression)were identified and managed. Finally, asthma treatment was optimized.Patients were aged between 25 and 70 years with 54% of them being atopic and 78% reporting an adult onset of their asthma. Median asthma duration was 23years. Thirty-two patients had three or more comorbidities, with chronic rhinosinusitis(72%), anxiety(68%)and obesity(54%) being the most prevalent. Poor adherence to treatment was found in 8patients. Different treatments were prescribed:nasal corticosteroid therapy(66%), proton pump inhibitors(24%) and anti-depressants(8%). CPAP was indicated for 4 patientes with severe OSAS. Formoterol was added to 11patients, tiotropium to 8 and montelukast to 6. We observed a significant improvement in as...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Airway pharmacology and treatment Source Type: research

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