Step-up and step-down approaches in the treatment of asthma.
Mario CazzolaMaria Gabriella MateraRogliani PaolaLuigino CalzettaJosuel OraPublished in: Expert review of respiratory medicine (2021)
Introduction: Significant intraindividual and temporal variability in symptom control is a feature of asthma that requires careful monitoring and the need to periodically review and adjust therapy. Both NHLBI/NAEPP and GINA offer helpful algorithms for a stepping approach to asthma.Areas covered: The problems arisen in applying the stepwise approach to the treatment of asthma proposed by NHLBI/NAEPP and GINA algorithms and their possible alternatives.Expert opinion: The current therapeutic stepping approach to asthma, which takes into account lung function, symptoms and quality of life, is certainly useful, but it does not consider the underlying mechanisms. Furthermore, patient's overestimation or underestimation of the severity of the disease and differences in the opinions on the level of asthma control required between patients and physicians and also between physicians in both primary care and specialist settings are common and may negatively affect asthma control and future risks. A reassessment of the conventional stepping approach to management of asthma is now needed. A pragmatic approach that sets therapeutic goals for each individual and associates them with the treatable traits of asthma which, when therapeutically targeted, will in many cases help to achieve the goals, seems more reasonable than the present stepping approach.
Keyphrases
- climate change
- lung function
- chronic obstructive pulmonary disease
- primary care
- cystic fibrosis
- air pollution
- allergic rhinitis
- machine learning
- mental health
- randomized controlled trial
- end stage renal disease
- risk assessment
- case report
- physical activity
- stem cells
- public health
- prognostic factors
- depressive symptoms
- chronic kidney disease
- peritoneal dialysis
- combination therapy
- clinical practice
- cell therapy