Uncontrolled asthma: A review of the prevalence, disease burden and options for treatment

Abstract

An estimated 300 million people are affected by asthma worldwide and the burden is likely to rise substantially in the next few decades. Estimates of the prevalence of asthma range from 7% in France and Germany to 11% in the USA and 15-18% in the United Kingdom. Approximately 20% of these patients have severe asthma, of which 20% is inadequately controlled. Patients with inadequately controlled severe persistent asthma are at a particularly high risk of exacerbations, hospitalization and death, and often have severely impaired quality of life. Current management of asthma focuses on a stepwise approach tailored to disease severity. In addition to needing high-dose inhaled corticosteroids (ICS) and long-acting beta(2)-agonists (LABAs), patients with severe persistent asthma often require additional controller medications, such as anti-leukotrienes, oral LABAs, oral corticosteroids and/or anti-IgE therapy. There is currently little evidence on which to base treatment decisions in patients with inadequately controlled severe persistent asthma already treated with ICS and LABAs. The anti-IgE monoclonal antibody omalizumab is the most recent addition to the list of treatment options for these patients and has been shown to reduce exacerbations and emergency visits and improve lung function, symptom scores and quality of life in patients with difficult-to-treat asthma whose symptoms remain inadequately controlled despite receiving ICS and LABAs. Comparative trials are needed to determine the merits of different treatments and strategies for patients with inadequately controlled severe persistent asthma and to identify patients likely to benefit from new treatment options.

The association between blood eosinophil count and benralizumab efficacy for patients with severe, uncontrolled asthma: subanalyses of the Phase III SIROCCO and CALIMA studies

“…Severe asthma requires medium-/high-dosage inhaled corticosteroids/long-acting b 2 -agonists (ICS/LABA) with add-on therapies (e.g., oral corticosteroids, anti-immunoglobulin E [omalizumab] or anti-interleukin-5 [IL-5] agents) to control the disease. For many patients, the disease remains uncontrolled, despite such extensive treatment 3 , placing them at risk of severe asthma exacerbations 4 . Thus, a significant unmet medical need remains.…”

“…Thus, a significant unmet medical need remains. Patients with severe, uncontrolled asthma have increased morbidity, reduced healthrelated quality of life and increased health care resource use, and, therefore, need additional therapeutic options [4][5][6][7] .…”

Prevalence of asthma-triggering drug use in adults and its impact on asthma control

“…The financial burden on asthmatics and health systems must also be considered. 8 The role of primary care in the successful treatment of asthma is significant. As many as 80 per cent of asthmatics rely on primary care professionals, whereas only a minority of asthmatics visit specialists.…”

Development and validation of an asthma knowledge questionnaire for use in Brazil

“…(3) Despite advances in specific medications for asthma, the prevalence and the morbidity of uncontrolled asthma is still high. (4) The treatment of asthma can be complex and requires the involvement of patients and their families. For the success in the treatment, patients with asthma should obtain specific knowledge about the disease, such as the pathophysiology of asthma, the purposes of the different types of medication, the management of environmental asthma triggers, the identification and manage-ment of asthma exacerbations, the use of inhalers, and the discrimination between controlled and uncontrolled asthma.…”