Reducing the hidden burden of severe asthma: recognition and referrals from primary practice.
Marc HumbertArnaud BourdinNikolaos G PapadopoulosStephen T HolgateNicola A HananiaDavid M G HalpinKenneth R ChapmanMarcela GavornikovaDavid J PriceAlan G KaplanLiam G HeaneyPublished in: The Journal of asthma : official journal of the Association for the Care of Asthma (2020)
Since their introduction many decades ago, systemic corticosteroids have become a mainstay treatment for asthma. Despite being a highly effective therapy, corticosteroids can cause significant adverse effects in patients. This results in a "double hit" for some patients as they suffer the burden of disease as well as the burden of treatment-induced morbidity.This article aims to raise awareness of the potential, harmful side effects of prolonged or repeated exposure to systemic corticosteroids in asthma. It also highlights the importance of referral of the appropriate patients with asthma from primary care for specialist assessment once other considerations such as adherence, inhaler technique and co-morbidity have been evaluated. We propose a simple decision step that may help busy primary care physicians and general practitioners to identify patients who could benefit from specialist assessment.Our decision step suggests that a patient with asthma should be reviewed at least once by an asthma specialist if he/she (i) has received ≥2 courses of oral corticosteroids in the previous year; asthma remains uncontrolled despite good adherence and inhaler technique; or (ii) has attended an emergency department or was hospitalized for asthma care.Such referral could facilitate wider access to diagnostic tools, in-depth assessment of confounding comorbidities, and non-corticosteroid-based therapies as needed, which may be unavailable in primary practice.
Keyphrases
- primary care
- chronic obstructive pulmonary disease
- lung function
- allergic rhinitis
- emergency department
- palliative care
- healthcare
- ejection fraction
- end stage renal disease
- newly diagnosed
- cystic fibrosis
- prognostic factors
- case report
- stem cells
- patient reported outcomes
- type diabetes
- metabolic syndrome
- chronic pain
- climate change
- drug induced
- high glucose
- bone marrow
- pain management
- adverse drug
- patient reported
- combination therapy
- electronic health record