Physician perspectives on the burden and management of asthma in six countries: The Global Asthma Physician Survey (GAPS)

Chapman, Kenneth R.; Hinds, David; Piazza, Peter; Rahérison, Chantal; Gibbs, Michael; Greulich, Timm; Gaalswyk, Kenneth; Lin, Jiangtao; Adachi, Mitsuru; Davis, Kourtney J.

doi:10.1186/s12890-017-0492-5

Cited by 56 publications

(53 citation statements)

References 37 publications

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“…The fifth paradox is that, although ICS/fast-onset LABA as reliever therapy has greater efficacy than SABA reliever therapy across steps 3 and 4 [29], in clinical practice most patients receive SABA reliever therapy at these steps. Furthermore, even those prescribed ICS/fast-onset LABA maintenance and reliever therapy are commonly co-prescribed a SABA [30]. This entrenched practice persists, not only despite the greater efficacy of ICS/fast-onset LABA reliever therapy compared with SABA reliever therapy at steps 3 and 4, but also despite the evidence that ICS/fast-onset LABA reliever therapy reduces the excessive use of β-agonist therapy, the number of days of β-agonist overuse associated with delay in obtaining medical help and the number of days without self-administration of ICS [31].…”

Section: Fifth Paradoxmentioning

confidence: 99%

The further paradoxes of asthma management: time for a new approach across the spectrum of asthma severity

et al. 2018

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@ERSpublicationsA paradigm shift in asthma management that addresses the paradoxes of SABA reliever therapy is required; consideration needs to be given to replacement of SABA reliever with ICS/fast-onset β-agonist reliever therapy across the range of asthma severity http://ow.ly/ccff30lNLPv Cite this article as: Beasley R, Bird G, Harper J, et al. The further paradoxes of asthma management: time for a new approach across the spectrum of asthma severity. Eur Respir J 2018; 52: 1800694 [https://doi.org/ 10.1183/13993003.00694-2018].Should short-acting β-agonist (SABA) reliever monotherapy be replaced by combination inhaled corticosteroid (ICS)/fast-onset β-agonist as reliever therapy in asthma patients at Global Initiative for Asthma step 1 [1]? This uncertainty is the latest chapter in the controversy relating to the risks and benefits of β-agonist therapy in asthma management [2]. This 70-year controversy began with the introduction of isoprenaline and the concerns that it caused severe refractory asthma and an increased risk of death [3][4][5].The dilemma of evaluating the relative efficacy and risk of β-agonists has persisted since then. Two asthma mortality epidemics in the 1960s and 1970s/1980s were primarily caused by use of high-dose preparations of the potent, yet poorly β 2 -selective agonists, isoprenaline [6] and fenoterol [7], respectively. The epidemics ended abruptly with regulatory restriction and withdrawal of these agents [2,8]. In response to evidence that regular scheduled use of SABAs could increase asthma severity and the risk of exacerbations, the recommendation for their use was changed to "as required for relief of symptoms". This therapeutic approach, together with the increasing use of ICSs, both as separate inhalers and combination ICS/long-acting β-agonist (LABA) inhalers, has been associated with a marked reduction in asthma mortality since the 1990s, although the global rates of asthma mortality have now plateaued [9]. There is clearly a need for alternative treatment strategies to achieve further reductions in global asthma mortality.One strategy is to reduce the potential risks associated with starting SABA reliever monotherapy in intermittent and mild persistent asthma. This strategy was the focus of a recent review in the European Respiratory Journal [1], which identified five paradoxes of this therapeutic approach. The review summarised evidence that SABA reliever monotherapy exposes patients to significant avoidable risk and leads to learned behaviours, which result in difficulties for both patients and doctors (table 1). SABA reliever therapy not only reduces the potential to achieve optimal control at step 1, but also when patients progress to higher treatment steps in the stepwise approach to pharmacological therapy. In this editorial,

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Section: Fifth Paradoxmentioning

confidence: 99%

The further paradoxes of asthma management: time for a new approach across the spectrum of asthma severity

et al. 2018

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“…Asthma is a common, heterogeneous disease, causing considerable morbidity affecting all age groups 1 . Adherence to international and national guidelines in asthma seems to be highly variable [2][3][4][5] . It is logical to assume that if clinical guidelines were better adopted it would also lead to better patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Planned primary health care asthma contacts during 12-year follow-up after Finnish National Asthma Programme: focus on spirometry

Takala

Ilmarinen

Tuomisto

et al. 2020

npj Prim. Care Respir. Med.

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Primary health care (PHC) providers are at the front line of asthma management. To evaluate how planned asthma follow-up occurred in PHC and whether lung function tests were used, 203 patients were followed for 12 years as part of a real-life asthma cohort Seinäjoki Adult Asthma Study (SAAS). A total of 152 patients had visits in PHC attending on average to four planned contacts during 12-year follow-up corresponding to one visit every third year. National guideline recommends annual visits. Patients with ≥4 contacts seemed to have more difficult asthma and better adherence to inhaled corticosteroid medication. Lung function tests were performed on average in 87.5% of annual planned follow-up contacts. Spirometry was performed in 70%, 71% and 97% of all contacts depending on whether it was a contact to GP, nurse or both. Overall, the frequency of follow-up contacts was insufficient but PHC adherence to lung function testing was excellent. npj Primary Care Respiratory Medicine (2020) 30:8 ; https://doi.Published in partnership with Primary Care Respiratory Society UK 1234567890():,; Female, n (%) 96 (63.2) Age 59 (13) BMI 28.5 (5.9) Smokers (ex or current), n (%) 76 (50.0) Atopic, n (%) a 51 (37.2) Rhinitis, n (%) 107 (71.8) Uncontrolled asthma, n (%) b 46 (30.3) Daily LABA in use, n (%) 78 (51.3) Daily add-on drug in use, n (%) 85 (83.3) Daily ICS in use, n (%) 125 (81.2)

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“…Of concern, physician insight into SMART application appears to be poor. In one study, 72% of physicians prescribed SMART, but a majority (91%) also prescribed a SABA at some point . Limited data also suggest that asthma control with combination budesonide‐formoterol is poorer in younger patients (age < 30 years) and those with a newer diagnosis (<5 years) .…”

Section: Caveatsmentioning

confidence: 99%

Single Maintenance and Reliever Therapy (SMART) Regimen for Management of Persistent Asthma

Mohan

Kearney

Miller

2018

Academic Emergency Medicine

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heading For every 16 patients who took single maintenance and reliever therapy (SMART), 1 case of asthma exacerbation was prevented Benefits in NNT NNT of 12 for prevention of one asthma exacerbation with SMART, compared to same-dose inhaled corticosteroid alone (NNT of 9 compared to higher dose inhaled corticosteroids alone) NNT of 16 for prevention of one asthma exacerbation with SMART, compared to the same dose of inhaled corticosteroid combined with a long-acting beta-agonist (NNT 37 compared to higher dose inhaled corticosteroid combined with a long-acting beta-agonist)Benefits in percentages 8.1% lower risk of asthma exacerbation with SMART, compared to same-dose inhaled corticosteroid alone (11% lower risk of asthma exacerbation when compared to higher dose inhaled corticosteroids alone) 6.3% lower risk of asthma exacerbation with SMART, compared to the same dose of inhaled corticosteroid combined with a long-acting beta-agonist (2.7% lower risk of asthma exacerbation when compared to higher dose inhaled corticosteroid combined with a long-acting beta-agonist) Harms in NNT (NNH) Harms were not assessed Harms in percentages Harms were not assessed Efficacy endpoints Asthma exacerbations defined as requiring systemic use of corticosteroids, hospitalization, ED visits, intensive care admission, or intubation Harm endpoints Harms were not assessed Who was in the studies 22,748 patients (aged ≥ 5 years) with persistent asthma, already receiving inhaled corticosteroids from 16 randomized clinical trials

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Physician perspectives on the burden and management of asthma in six countries: The Global Asthma Physician Survey (GAPS)

Cited by 56 publications

References 37 publications

The further paradoxes of asthma management: time for a new approach across the spectrum of asthma severity

The further paradoxes of asthma management: time for a new approach across the spectrum of asthma severity

Planned primary health care asthma contacts during 12-year follow-up after Finnish National Asthma Programme: focus on spirometry

Single Maintenance and Reliever Therapy (SMART) Regimen for Management of Persistent Asthma

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